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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 31, 'gender': 'M', 'symptoms': 'UTI\nConfusion/dementia', 'medical_history': ['CAD s/p CABG (___) and ICD (___)', 'CVA', 'HTN', 'HLD', 'dilated ischemic CM', 'COPD', 'central sleep apnea', 'BPH'], 'family_history': 'Father- CAD/ MI\nMother - CAD, DM', 'present_illness': '___ M with h/o CAD s/p CABG and ICD, CVA on warfarin presenting \nto the ED with confusion following an unwitnessed fall yesterday \nevening. Pt states that he could recall all events last evening \nand felt fine this AM. He did hit his head but denies LOC, \nheadache, vision changes, neck pain, focal numbness/weakness, \ndizziness, tonic-clonic movements and loss of continence. Pt \nworks as a ___ at ___ and went to work this \nmorning. His office staff felt he was not his usual self and \ncalled EMS to bring him to be evaluated. He has been ambulatory \nsince the event without pain.\n\nIn the ED, initial VS were 98.2, BP 76/42, HR 64, RR 18, 99%RA. \nHe was asymptomatic while in the ED. Pt received 2L NS and his \nBP improved (SBP range 85-108). A foley was placed. His UA \nshowed >182 WBCs with many bacteria and +nitrates. Additonal lab \ntests showed a blood WBC of 13.5, creatinine of 2.4 (was 0.8 in \n___, potassium of 5.8 (specimen labeled hemolyzed), lactate of \n2.1, AST 249, ALT 306, INR 2.2. Troponins were <0.01. Urine tox \nwas positive for benzodiazepines. He was given 1gm Ceftriaxone \nIV in the ED. ECG in the ED shows atrial pacing and non-specific \nST changes in the lateral leads unchanged from ___ ECG.\n\nTransfer VS were 97.5, BP 108/53, HR 60, RR 17, 97%RA.\n\nOn arrival to the floor, patient reports that he feels well. \nDoes report dysuria but unable to further define. Denies any \npain, fever, chills, dizziness, chest pain, vision changes, \nheadaches or weakness. Pt is oriented only to place and person. \nSpoke with daughter ___ by phone who states that his \nmental capacity has been slowly deteriorating since his \nstroke(s). Mostly short term memory at first but now seems to \nbe affecting all areas of his life. He is not able to manage \nhis finances on his own and frequently falls. Per daughter, pt \nhas been taking unspecified quantities of vallium/ativan to \nsleep at night. Unclear where he is getting these prescriptions. \n Unclear what medications/dosages pt is on, left message with \nPCP for ___ med list.', 'medications': [{'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION EXAM:\nVS - 99.1, BP 98/68, HR 59, RR 18, 98%RA\nGeneral: NAD, lying in bed, AAO x2 (person, place)\nHEENT: Bruising on right frontal and central occipital regions \nof head, PERRLA, EOMI, MMM, OP clear\nNeck: Supple, no masses, no JVD, no carotid bruits\nCV: Heart sounds distant, normal S1/S2, no murmurs or rubs\nLungs: CTAB, no wheeze, rales or rhonchi\nAbdomen: Soft, NT, ND, NABS, no rebound or guarding, no \norganomegaly\nGU: No CVAT, Foley in place draining dark yellow urine\nExt: Warm, well perfused, pulses 1+ bilaterally, no cyanosis, \nclubbing or edema \nNeuro: CN ___ grossly intact, gait not assessed as high fall \nrisk\nSkin: dry, ecchymoses on arms and legs\n\nDISCHARGE EXAM:\nVS - 98.0F, BP 100/61, HR 63, RR 18, 99% RA\nGeneral: NAD, sitting up in bed, A&O x3\nHEENT: bruising on right frontal and central occipital areas of \nscalp, PERRLA, MMM, EOMI, OP clear\nNeck: Supple, no masses or JVD\nCV: Heart sounds very distant, normal S1/S2, no rubs or \ngallops; pacer site on left upper chest non-erythematous\nLungs: CTAB, no wheeze, rales or rhonchi\nAbdomen: Soft, NT/ ND, no guarding, no rebound tenderness, no \norganomegaly, NABS\nGU: Good rectal tone, +internal and external hemorroids, no \nevidence of frank blood, Hemmocult negative; prostate enlarged \nand symmetric, no nodules or tenderness on exam\nBack: No CVAT\nExt: Warm, well perfused, pulses 1+, no cyanosis, clubbing or \nedema\nNeuro: Speech fluent, CN ___ grossly intact, gait not examined \n(pt refused)', 'diagnoses': [{'icd_code': 'R591', 'desc': 'Generalized enlarged lymph nodes'}, {'icd_code': 'R5383', 'desc': 'Other fatigue'}, {'icd_code': 'R634', 'desc': 'Abnormal weight loss'}, {'icd_code': 'R079', 'desc': 'Chest pain, unspecified'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': "ADMISSION LABS:\n___ 10:55AM BLOOD WBC-13.5* RBC-3.85*# Hgb-11.5* Hct-34.8* \nMCV-90# MCH-29.8 MCHC-33.0 RDW-14.0 Plt ___\n___ 10:55AM BLOOD Neuts-79.5* Lymphs-11.5* Monos-7.8 \nEos-0.9 Baso-0.3\n___ 10:55AM BLOOD ___ PTT-30.5 ___\n___ 10:55AM BLOOD Glucose-141* UreaN-70* Creat-2.4*# Na-136 \nK-5.8* Cl-104 HCO3-22 AnGap-16\n___ 10:55AM BLOOD ALT-249* AST-306* AlkPhos-108 TotBili-0.6\n___ 10:55AM BLOOD Lipase-68*\n___ 10:55AM BLOOD cTropnT-<0.01\n___ 10:55AM BLOOD ___ Ethanol-NEG Acetmnp-NEG \nBnzodzp-POS Barbitr-NEG Tricycl-NEG\n___ 11:11AM BLOOD Lactate-2.1* K-4.4\n\nPERTINENT LABS:\n___ 07:35AM BLOOD WBC-11.5* RBC-3.77* Hgb-10.8* Hct-34.4* \nMCV-91 MCH-28.5 MCHC-31.3 RDW-13.8 Plt ___\n___ 07:35AM BLOOD ___ PTT-31.4 ___\n___ 07:35AM BLOOD Glucose-97 UreaN-51* Creat-1.6* Na-140 \nK-4.3 Cl-110* HCO3-21* AnGap-13\n___ 07:35AM BLOOD ALT-181* AST-133* AlkPhos-101\n___ 08:10AM BLOOD VitB12-1500*\n___ 08:10AM BLOOD TSH-1.5\n\nDISCHARGE LABS:\n___ 08:10AM BLOOD WBC-9.9 RBC-3.82* Hgb-11.5* Hct-34.9* \nMCV-92 MCH-30.0 MCHC-32.8 RDW-14.0 Plt ___\n___ 08:10AM BLOOD ___ PTT-31.3 ___\n___ 08:10AM BLOOD Glucose-101* UreaN-40* Creat-1.3* Na-145 \nK-4.7 Cl-111* HCO3-26 AnGap-13\n___ 08:10AM BLOOD ALT-143* AST-74* AlkPhos-109 TotBili-0.8\n___ 08:10AM BLOOD Calcium-8.4 Phos-2.8 Mg-1.7\n\nMICROBIOLOGY:\n___ 10:55 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n\n___ 1:00 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n KLEBSIELLA PNEUMONIAE. >100,000 ORGANISMS/ML..\n Cefazolin interpretative criteria are based on a dosage \nregimen of\n 2g every 8h. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n KLEBSIELLA PNEUMONIAE\n | \nAMPICILLIN/SULBACTAM-- 4 S\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- 64 I\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\n\nIMAGING:\n___ ECG- Possible demand atrial pacing with small atrial \npacing artifact. Borderline low QRS voltage. Diffuse \nnon-specific repolarization abnormalities. Compared to the \nprevious tracing of ___ atrial pacing may now be present. \n\n___ CXR\nIMPRESSION: No evidence of pneumonia.\n\n___ CT HEAD W/O CONTRAST\nIMPRESSION: No acute intracranial abnormality.\n\n___ CT NECK W/O CONTRAST\nIMPRESSION: No acute fracture or subluxation.\n___ M with h/o CAD s/p CABG and ICD, CVA on warfarin presenting \nto the ED with confusion following an unwitnessed fall yesterday \nevening. Pt is a practicing pediatrician at ___. His \noffice staff felt he was not his usual self and called EMS to \nbring him to the ED to be evaluated.\n\nACTIVE ISSUES:\n#Syncope/Falls: Pt had unwitnessed fall on the evening of \n___ but denied LOC, headache, weakness, vision changes, neck \npain. His office staff noticed bruising/lacerations on his scalp \nand felt that he wasn't his usual self so they sent him to the \nED by EMS. In ED, CT head/neck negative for acute intracranial \nprocess or fracture. Urine tox from ED was + for \nbenzodiazepines. Pt was also hypotensive (76/42, asymptomatic) \nwhich improved to SBP ranging from 90-100s after receiving 2L \nNS. Per daughter, pt likely demented at baseline but does not \nhave an official diagnosis. Pt has undergone past \nneurocognitive eval. Likely culprits include concurrent UTI, \nhypotension, poor PO intake, medication side effect and \narrhythmia. He would take valium/ativan at night to sleep. While \non the floor, pt was AAOx3 and had difficulty with STM. His MMSE \nwas ___. EP interrogated his device and found that the device \nwas working normally and had no recorded events. ___ saw the pt \nand determined that he was safe for discharge to home and did \nnot require any additional assistance. Per family, pt was at his \nbaseline for the majority of this admission and only experienced \nconfusion at night. Social work (___) spoke with Dr. \n___ family at length concerning his congition and ability \nto care for himself. The Medicine team also spoke with ___ \nethics/legal departments to determine what our responsibilities \nwere in terms of reporting and required investigation. Discussed \nwith the pt at length that he is to no longer use \nvalium/Ativan/rozerem as these further impair his cognition. He \nwas also asked to refrain from seeing his own patients, taking \nnight call and driving. We asked that he discuss these \nconditions with his PCP. Pt has meeting the ___ \n___ on ___ to discuss his most recent \nneurocognitive eval and the impact on his ability to practice \nmedicine in the future.\n\n#UTI: Pt reported dysuria and urgency but unsure of how long he \nhad been experiencing these symptoms. Urine cultures sent by ED \ngrew pan sensitive Klebsiella. He was originally given CTX for 3 \ndays and then narrowed to Ciprofloxacin PO per sensitivities. \nPt reported improvement of symptoms prior to discharge. He was \ndischarged on a 7 day course of PO Cipro and treated with abx \nfor 10 days total. \n\n___: Likely prerenal secondary to hypotension (poor PO intake \nand low SBP). Pt baseline Cr was 1.5. In ED, Cr was 2.4. Cr \nnormalized to baseline after receiving 2L NS in ED. \n\n#Hypotension: Per PCP office visit on ___, low blood \npressure relatively new for this pt (normally hypertensive). SBP \nrange this admission was 90-100s. Pt reports that he was \nasymptomatic all throughout his hospitalization and denies \ndizziness/ lightheadedness, SOB, CP or abd pain. Held BP meds \n(carvedilol, lisinopril, valsartan) in hospital and recommended \nthat pt hold these meds until he could see his PCP. We did \nrestart his lisinopril (home dose 2.5mg BID)upon discharge for \ncardioprotective effects. \n\n#elevated LFTs: Pt asymptomatic. LFTs from PCP visit on ___ \nwere normal (20s). Were elevated this admission likely secondary \nto hypotension. AST- 306, ALT- 249. Trending down at time of \ndischarge (AST- 74, ALT- 143). Recommended follow up with PCP. \nHeld sotalol and simvastatin during admission to prevent further \nliver injury.\n\nCHRONIC ISSUES\n#CAD s/p CABG and ICD: Stable this admission on home regimen of \n___ and Coumadin. Pt monitored on telemetry this \nadmission. ICD interrogated by EP and found to be working \nnormally. Pt likely has CHF with his last EF being 25% in ___. \n\n#HTN: Pt has long standing hypertension, but is generally \nnormotensive while on medication (as per PCP office notes). Pt \nwas hypotensive this admission but was asymptomatic. His home \ncarvedilol, lisinopril and valsartan were held during this \nadmission in the setting of low blood pressure.\n\n#Afib: Stable this admission. Held home sotalol 80mg in the \nsetting of elevated LFTs. Asked pt not to take this medication \nuntil his LFTs could be remeasured by his PCP as an outpatient. \nContinued on Coumadin 0.5mg every other day as per PCP ___. \nReiterated importance of regular INR checks to pt. \n\n#HLD: Stable this admission. Home simvastatin 20mg held in the \nsetting of elevated LFTs. Asked pt to not take this medication \nuntil his LFTs could be remeasured by his PCP as an outpatient.\n\n#CVA: H/o multiple prior CVAs, the last being in ___. Stable \nthis admission. Continued home ___ \n\nTRANSITIONAL ISSUES: \n-Use of valium/Ativan/rozerem and resulting impairment of \ncognition, associated unsteadiness and the methods used to \nobtain these medications.\n-Appropriateness of seeing patients unsupervised, taking night \ncall and driving a car\n-elevated LFTs: please check serum lytes within one week of \ndischarge, assess need for further evaluation\n-UTI: monitor for resolution, consider urine dipstick or UA\n-Proper use of ___ and the importance of \nregularly checking an INR"}}
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{'final_diagnoses': ['UTI', 'Confusion/dementia'], 'procedures': ['None'], 'visit_summary': "___ M with h/o CAD s/p CABG and ICD, CVA on warfarin presenting \nto the ED with confusion following an unwitnessed fall yesterday \nevening. Pt is a practicing pediatrician at ___. His \noffice staff felt he was not his usual self and called EMS to \nbring him to the ED to be evaluated.\n\nACTIVE ISSUES:\n#Syncope/Falls: Pt had unwitnessed fall on the evening of \n___ but denied LOC, headache, weakness, vision changes, neck \npain. His office staff noticed bruising/lacerations on his scalp \nand felt that he wasn't his usual self so they sent him to the \nED by EMS. In ED, CT head/neck negative for acute intracranial \nprocess or fracture. Urine tox from ED was + for \nbenzodiazepines. Pt was also hypotensive (76/42, asymptomatic) \nwhich improved to SBP ranging from 90-100s after receiving 2L \nNS. Per daughter, pt likely demented at baseline but does not \nhave an official diagnosis. Pt has undergone past \nneurocognitive eval. Likely culprits include concurrent UTI, \nhypotension, poor PO intake, medication side effect and \narrhythmia. He would take valium/ativan at night to sleep. While \non the floor, pt was AAOx3 and had difficulty with STM. His MMSE \nwas ___. EP interrogated his device and found that the device \nwas working normally and had no recorded events. ___ saw the pt \nand determined that he was safe for discharge to home and did \nnot require any additional assistance. Per family, pt was at his \nbaseline for the majority of this admission and only experienced \nconfusion at night. Social work (___) spoke with Dr. \n___ family at length concerning his congition and ability \nto care for himself. The Medicine team also spoke with ___ \nethics/legal departments to determine what our responsibilities \nwere in terms of reporting and required investigation. Discussed \nwith the pt at length that he is to no longer use \nvalium/Ativan/rozerem as these further impair his cognition. He \nwas also asked to refrain from seeing his own patients, taking \nnight call and driving. We asked that he discuss these \nconditions with his PCP. Pt has meeting the ___ \n___ on ___ to discuss his most recent \nneurocognitive eval and the impact on his ability to practice \nmedicine in the future.\n\n#UTI: Pt reported dysuria and urgency but unsure of how long he \nhad been experiencing these symptoms. Urine cultures sent by ED \ngrew pan sensitive Klebsiella. He was originally given CTX for 3 \ndays and then narrowed to Ciprofloxacin PO per sensitivities. \nPt reported improvement of symptoms prior to discharge. He was \ndischarged on a 7 day course of PO Cipro and treated with abx \nfor 10 days total. \n\n___: Likely prerenal secondary to hypotension (poor PO intake \nand low SBP). Pt baseline Cr was 1.5. In ED, Cr was 2.4. Cr \nnormalized to baseline after receiving 2L NS in ED. \n\n#Hypotension: Per PCP office visit on ___, low blood \npressure relatively new for this pt (normally hypertensive). SBP \nrange this admission was 90-100s. Pt reports that he was \nasymptomatic all throughout his hospitalization and denies \ndizziness/ lightheadedness, SOB, CP or abd pain. Held BP meds \n(carvedilol, lisinopril, valsartan) in hospital and recommended \nthat pt hold these meds until he could see his PCP. We did \nrestart his lisinopril (home dose 2.5mg BID)upon discharge for \ncardioprotective effects. \n\n#elevated LFTs: Pt asymptomatic. LFTs from PCP visit on ___ \nwere normal (20s). Were elevated this admission likely secondary \nto hypotension. AST- 306, ALT- 249. Trending down at time of \ndischarge (AST- 74, ALT- 143). Recommended follow up with PCP. \nHeld sotalol and simvastatin during admission to prevent further \nliver injury.\n\nCHRONIC ISSUES\n#CAD s/p CABG and ICD: Stable this admission on home regimen of \n___ and Coumadin. Pt monitored on telemetry this \nadmission. ICD interrogated by EP and found to be working \nnormally. Pt likely has CHF with his last EF being 25% in ___. \n\n#HTN: Pt has long standing hypertension, but is generally \nnormotensive while on medication (as per PCP office notes). Pt \nwas hypotensive this admission but was asymptomatic. His home \ncarvedilol, lisinopril and valsartan were held during this \nadmission in the setting of low blood pressure.\n\n#Afib: Stable this admission. Held home sotalol 80mg in the \nsetting of elevated LFTs. Asked pt not to take this medication \nuntil his LFTs could be remeasured by his PCP as an outpatient. \nContinued on Coumadin 0.5mg every other day as per PCP ___. \nReiterated importance of regular INR checks to pt. \n\n#HLD: Stable this admission. Home simvastatin 20mg held in the \nsetting of elevated LFTs. Asked pt to not take this medication \nuntil his LFTs could be remeasured by his PCP as an outpatient.\n\n#CVA: H/o multiple prior CVAs, the last being in ___. Stable \nthis admission. Continued home ___ \n\nTRANSITIONAL ISSUES: \n-Use of valium/Ativan/rozerem and resulting impairment of \ncognition, associated unsteadiness and the methods used to \nobtain these medications.\n-Appropriateness of seeing patients unsupervised, taking night \ncall and driving a car\n-elevated LFTs: please check serum lytes within one week of \ndischarge, assess need for further evaluation\n-UTI: monitor for resolution, consider urine dipstick or UA\n-Proper use of ___ and the importance of \nregularly checking an INR", 'medications_prescribed': ['1. Aspirin 81 mg PO DAILY', '2. Clopidogrel 75 mg PO DAILY', '3. Warfarin 0.5 mg PO EVERY OTHER DAY \nYou should also have your INR followed by your PCP.', '4. Lisinopril 2.5 mg PO BID', '5. alfuzosin *NF* 20 mg Oral qhs', '6. Rozerem *NF* (ramelteon) 8 mg Oral hs - ERROR, CONTACTED ___ \nAND SON BY PHONE WITH UPDATE ON ___ NOTE CAN BE SEEN IN OMR', '7. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days \nRX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice per day Disp \n#*14 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'Vomiting', 'medical_history': ['1. Diabetes complicated by peripheral neuropathy, h/o DKA ', '2. Depression ', '3. Recurrent Alcohol Abuse with multiple admissions for detox, \nno h/o DT or w/d seizures ', '4. Cirrhosis, Childs A ', '5. Chronic pancreatitis ', '6. Prior suicidal ideation ___ ', '7. GERD', '8. HTN', '9. HLD'], 'family_history': 'Mother - Died of ___\nBrother - Died of ___\nBrother - DM', 'present_illness': "Ms. ___ is a ___ year old woman with history of alcohol abuse \nc/b cirrhosis and chronic pancreatitis, T2DM, and recurrent \nCdiff infections who presents with vomiting and acute alcohol \nintoxication.\n\nPatient reports that three days ago she began having episodes of \nvomiting, and could not keep down any PO. Initially was vomiting \nonly stomach contents, but eventually became dark brown with \nsome streaks of bright red blood.\n\nNo diarrhea, no blood in stool or dark black stools.\n\nPrior to this episode, she had been drinking ___ pint of vodka \nper day, but did not have any vodka for the past 3 days. Today, \nshe felt like she couldn't deal with this and drank a small \namount of vodka. Her social worker came by her apartment this \nafternoon and referred the patient to the ED.", 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Nicotine Polacrilex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '0.59', 'valuenum': 0.59, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.9', 'valuenum': 88.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '345', 'valuenum': 345.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.64', 'valuenum': 3.64, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.90', 'valuenum': 0.9, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.03', 'valuenum': 14.03, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '48.0', 'valuenum': 48.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test. New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.3, . estimated GFR (eGFR) is likely between 41 and 50 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 277.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '321', 'valuenum': 321.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3155.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 353.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test. New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-62', 'valuenum': -62.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 123.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 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'priority': 'ROUTINE', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.9', 'valuenum': 49.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.08', 'valuenum': 3.08, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51.7', 'valuenum': 51.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2778.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 353.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93.1', 'valuenum': 93.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.67', 'valuenum': 0.67, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.4', 'valuenum': 87.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.49', 'valuenum': 2.49, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.12', 'valuenum': 0.12, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.66', 'valuenum': 0.66, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.25', 'valuenum': 12.25, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '52.0', 'valuenum': 52.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.8', 'valuenum': 50.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'ng/mL', 'ref_range_lower': 0.6, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.85', 'valuenum': 0.85, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.8', 'valuenum': 87.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.15', 'valuenum': 0.15, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.76', 'valuenum': 0.76, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.07', 'valuenum': 15.07, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '50.6', 'valuenum': 50.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93.2', 'valuenum': 93.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.82', 'valuenum': 2.82, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51.1', 'valuenum': 51.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 183.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '78', 'valuenum': 78.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 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'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 25.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 285.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 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'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 216.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.87', 'valuenum': 0.87, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 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5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 22.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.00', 'valuenum': 1.0, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86.0', 'valuenum': 86.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.81', 'valuenum': 0.81, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.91', 'valuenum': 12.91, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '49.6', 'valuenum': 49.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 234.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '350', 'valuenum': 350.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '367', 'valuenum': 367.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.83', 'valuenum': 0.83, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85.1', 'valuenum': 85.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.58', 'valuenum': 2.58, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.65', 'valuenum': 0.65, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.78', 'valuenum': 9.78, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '49.4', 'valuenum': 49.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<5.'}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely between 55 and 67 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 253.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '303', 'valuenum': 303.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '___:\nADMISSION EXAM\n==============\nVITALS: Reviewed in Metavision \nGENERAL: Alert, oriented; mild distress\nHEENT: Sclera anicteric, PERRL but sluggish \nLUNGS: Clear to auscultation bilaterally\nCV: Tachycardic, normal S1 S2, no murmurs, rubs, gallops \nABD: Soft, non-distended, tender to palpation especially in \nepigastrum but no rebound or guarding\nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: Excoriations and erythema in perineal area \nNEURO: AOx3, mild tremor but no asterixis \nACCESS: Left femoral line\n\nDISCHARGE EXAM\nVS: T98.0, BP 136 / 88, HR 93, RR 18, O2 sat 100 RA\nGENERAL: Comfortable appearing woman, pleasant, in no distress \nHEENT: Sclera anicteric. No oropharyngeal erythema. MMM. \nLUNGS: Clear to auscultation bilaterally, no w/r/r\nCV: RRR, normal S1 S2, no murmurs, rubs, gallops \nABD: Soft, non-distended. Minor tenderness in the epigastric \narea\nwithout guarding. \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or\nedema \nSKIN: warm and dry\nNEURO: AOx3, mild tremor but no asterixis', 'diagnoses': [{'icd_code': 'I2699', 'desc': 'Other pulmonary embolism without acute cor pulmonale'}, {'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'J810', 'desc': 'Acute pulmonary edema'}, {'icd_code': 'J9621', 'desc': 'Acute and chronic respiratory failure with hypoxia'}, {'icd_code': 'J440', 'desc': 'Chronic obstructive pulmonary disease with (acute) lower respiratory infection'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'J441', 'desc': 'Chronic obstructive pulmonary disease with (acute) exacerbation'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'I824Z3', 'desc': 'Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral'}, {'icd_code': 'I482', 'desc': 'Chronic atrial fibrillation'}, {'icd_code': 'Y95', 'desc': 'Nosocomial condition'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'M797', 'desc': 'Fibromyalgia'}, {'icd_code': 'E7800', 'desc': 'Pure hypercholesterolemia, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'T380X5A', 'desc': 'Adverse effect of glucocorticoids and synthetic analogues, initial encounter'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'I341', 'desc': 'Nonrheumatic mitral (valve) prolapse'}, {'icd_code': 'M329', 'desc': 'Systemic lupus erythematosus, unspecified'}, {'icd_code': 'G540', 'desc': 'Brachial plexus disorders'}, {'icd_code': 'Z981', 'desc': 'Arthrodesis status'}, {'icd_code': 'Z8701', 'desc': 'Personal history of pneumonia (recurrent)'}, {'icd_code': 'Z95818', 'desc': 'Presence of other cardiac implants and grafts'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'Z9981', 'desc': 'Dependence on supplemental oxygen'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': 'ADMISSION LABS\n==============\n___ 04:10PM BLOOD WBC-26.9* RBC-5.19 Hgb-12.8 Hct-43.7 \nMCV-84 MCH-24.7* MCHC-29.3* RDW-17.8* RDWSD-53.0* Plt ___\n___ 04:10PM BLOOD Neuts-81* Bands-2 Lymphs-7* Monos-7 Eos-0 \nBaso-1 Atyps-1* Metas-1* Myelos-0 AbsNeut-22.33* AbsLymp-2.15 \nAbsMono-1.88* AbsEos-0.00* AbsBaso-0.27*\n___ 04:10PM BLOOD Plt Smr-NORMAL Plt ___\n___ 06:15PM BLOOD ___ PTT-24.7* ___\n___ 06:15PM BLOOD Glucose-591* UreaN-24* Creat-1.5* Na-133* \nK-3.9 Cl-81* HCO3-2* AnGap-50*\n___ 04:10PM BLOOD ALT-<5 AST-101* AlkPhos-230* TotBili-0.9\n___ 04:10PM BLOOD ___ 04:10PM BLOOD Albumin-4.4 Calcium-8.4 Phos-11.1* Mg-2.4\n___ 04:10PM BLOOD ASA-NEG Ethanol-52* Acetmnp-NEG \nTricycl-NEG\n___ 06:25PM BLOOD Glucose-GREATER TH Lactate-11.3* Na-127* \nK-3.8 Cl-76*\n\nNOTABLE LABS\n============\n___ 04:10PM BLOOD cTropnT-<0.01\n___ 05:31AM BLOOD cTropnT-<0.01\n___ 04:10PM BLOOD Triglyc-488*\n\nMICRO\n=====\n___ 10:44 pm STOOL CONSISTENCY: NOT APPLICABLE\n Source: Stool. \n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n Reported to and read back by ___ @ 0713 ON \n___ - ___. \n CLOSTRIDIUM DIFFICILE. \n Positive for toxigenic C difficile by the Cepheid \nnucleic\n amplification assay. (Reference \nRange-Negative). \n\n___ 12:15 am URINE Site: NOT SPECIFIED\n URINE CULTURE (Final ___: NO GROWTH. \n\n___ 6:45 pm BLOOD CULTURE\n Blood Culture, Routine (Final ___: NO GROWTH. \n\nPATHOLOGY EGD\n=============\nPATHOLOGIC DIAGNOSIS:\nEsophageal biopsy: Fibrinno purulent exudate suggestive of \nulceration: GMS stain is negative the Brown Brenn reveals \nbacterial colonization\n___ year old female with history of ETOH abuse, Child Class A \ncirrhosis, DMII, recurrent acute on chronic pancreatitis, \nrecurrent C. diff who presented to the ED with vomiting \ntransferred to medicine for ongoing management of acute on \nchronic pancreatitis, diabetes, and monitoring for ETOH \nwithdrawal, found to have severe esophagitis on EGD. Course \ncomplicated by Cdiff infection and vulvo-vaginitis.'}}
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{'final_diagnoses': ['Acute on Chronic Pancreatitis', 'Esophagitis', 'Alcohol abuse', 'Cdiff infection', 'Diabetes ', 'Vulvovaginitis '], 'procedures': ['___ femoral line placement', '___ PICC placement', '___ EGD'], 'visit_summary': '___ year old female with history of ETOH abuse, Child Class A \ncirrhosis, DMII, recurrent acute on chronic pancreatitis, \nrecurrent C. diff who presented to the ED with vomiting \ntransferred to medicine for ongoing management of acute on \nchronic pancreatitis, diabetes, and monitoring for ETOH \nwithdrawal, found to have severe esophagitis on EGD. Course \ncomplicated by Cdiff infection and vulvo-vaginitis.', 'medications_prescribed': ['1. Nystatin Ointment 1 Appl TP QID:PRN vaginal itching \nRX *nystatin 100,000 unit/gram four times a day Refills:*0 ', '2. Ranitidine 150 mg PO QHS \nRX *ranitidine HCl 150 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0 ', '3. Sucralfate 1 gm PO QID \nthrough ___ \nRX *sucralfate 1 gram 1 tablet(s) by mouth four times a day Disp \n#*14 Tablet Refills:*0 ', '4. Omeprazole 40 mg PO BID \ntwice daily through ___ \nRX *omeprazole 40 mg 1 capsule(s) by mouth twice a day Disp #*60 \nCapsule Refills:*0 ', '5. Vancomycin Oral Liquid ___ mg PO BID Duration: 1 Week \n___ \nRX *vancomycin 125 mg 1 capsule by mouth twice a day Disp #*14 \nCapsule Refills:*0 ', '6. Vancomycin Oral Liquid ___ mg PO DAILY Duration: 1 Week \n___ \nRX *vancomycin 125 mg 1 capsule by mouth daily Disp #*7 Capsule \nRefills:*0 ', '7. Vancomycin Oral Liquid ___ mg PO EVERY OTHER DAY Duration: 2 \nWeeks \n___ \nRX *vancomycin 125 mg 1 capsule by mouth every other day Disp \n#*7 Capsule Refills:*0 ', '8. Atorvastatin 40 mg PO QPM ', '9. BusPIRone 15 mg PO TID ', '10. Creon 12 1 CAP PO TID W/MEALS ', '11. Cyanocobalamin 100 mcg PO DAILY ', '12. DULoxetine 60 mg PO DAILY ', '13. Fluorometholone 0.1% Ophth Susp. 1 DROP BOTH EYES BID ', '14. FoLIC Acid 1 mg PO DAILY ', '15. Gabapentin 300 mg PO TID ', '16. HumaLOG KwikPen Insulin (insulin lispro) 7 U subcutaneous \nTID W/MEALS ', '17. Losartan Potassium 50 mg PO DAILY ', '18. MetFORMIN (Glucophage) 1000 mg PO BID ', '19. Multivitamins 1 TAB PO DAILY ', '20. Thiamine 100 mg PO DAILY ', '21. Tresiba FlexTouch U-100 (insulin degludec) 62 U \nsubcutaneous QHS ', '22. Vancomycin Oral Liquid ___ mg PO QID Duration: 5 Days \nthrough ___ \nRX *vancomycin 125 mg 1 capsule(s) by mouth four times a day \nDisp #*18 Capsule Refills:*0 ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 51, 'gender': 'M', 'symptoms': 'Chest pain, dizziness', 'medical_history': ['Type 2 diabetes mellitus, Insulin-dependent', 'Gout', 'Hypertension', 'Atrial Fibrillation', 'OSA (normally on BiPAP)', 'CVA- in ___ (Left hemiparesis, she only has a slight \nresidual deficit. She stopped working after her stroke).', 'Hyperlipidemia', 'MI in ___', 'GERD', 'Rheumatoid Arthritis', 'Chronic Myopathy (possibly colchicine induced v. \npolyu-arthritis v. inflammatory).'], 'family_history': '1. Mother has HTN and is aged ___\n2. Father had type 2 diabetes mellitus\n3. One son died after transplant surgery, organ failure related \nto an MI.\n4. One son died of liver cancer', 'present_illness': 'Briefly, patient is a ___ year old female with history of \ndiabetes, CAD, PAF, presents with chest heaviness and dizziness \nx 24hrs. \n.\nHer symptoms began on ___ with dizziness. She reports this \nis her usual dizziness that worsens when she bends down or \nstands up. It resolved as it always does. However on ___, \nwhile at rest, she had chest pressure/"heaviness". When she \ntried to get out of bed at home, patient experienced dizziness \nbut also had a few seconds of diplopia, which was new for her. \nShe immediately sat down on the floor but then felt weak. She \nwent to the bathroom and vomited. She again sat down and \ndiplopia resolved on its own, however the chest pain persisted. \nShe also reported some shortness of breath at the time of all of \nthis. Chest pain is described as a pressure that she initally \nrated at a ___ on admission). Reported some left arm \nnumbness but no syncope. Her chest pressure persisted even \nafter arriving to the ED, although it resolved by the time she \nwent for CXR (after receiving aspirin and SL nitro). While in \nX-ray, she described three short pains in her chest at CXR that \nwere self-resolved. \n.\nIn the ED her vitals were T-99.2, HR- 68, BP- 183/94, RR- 16, \nSaO2- 100 RA. Troponin was elevated to 0.06, CK was 1118, MB was \n13 and MBI was 1.2 (all unchanged from her baseline). ___ \n___ reported as negative. ECG was unchanged from prior. A \nCXR showed was unrevealing. A CT was without intracranial bleed. \nShe was given aspirin and NGL SL. Vitals on transfer to medical \nfloor were 97.7, 56, 148/63, 16, 98% RA.\n. \nUpon transfer to the floor, she still felt weak but denied any \nchest pain, shortness of breath or dizziness. At baseline she \nhas some ankle edema, occasionally wakes up short of breath and \nhas had occasional chest tightness in the past. She was recently \nseen (on ___ by her nurse practitioner who stopped statin and \nzetia secondary to elevated CK. In addition, nifedipine was \nstopped and lasix increased (from 40mg to 60mg daily) due to \nincreased ankle swelling.\n. \nOn review of systems, notable for absence of chest pain, dyspnea \non exertion, orthopnea, ankle edema, palpitations, syncope or \npresyncope, myalgias, joint pains, cough, hemoptysis, black \nstools or red stools. She denies recent fevers, chills or \nrigors. All of the other review of systems were negative. ', 'medications': [{'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [], 'exams': 'VS - T-96.9, BP- 172/90, HR- 53, RR- 18, SaO2- 99% RA\nGen: NAD. Oriented x3. Mood, affect appropriate.\nHEENT: Sclera anicteric. Right pupil did not constrict either to \ndirect or consentual light, left pupil normal. EOMI. Conjunctiva \nwere pink, no pallor or cyanosis of the oral mucosa.\nCV: Irregular rhythm but normal rate. +S1, S2. No m/r/g. No \nthrills, lifts. No S3 or S4.\nChest: CTAB, no crackles, wheezes or rhonchi.\nAbd: Soft, non-distended, non-distended. No HSM. \nExt: +1 pitting edema on ___ b/l.\nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\nNeuro: CN II-XII intact with the exception of inability to \naccomadate with either eye. Unable to elicit diploplia on exam. \nStrength ___ on LLE and ___ biceps and ___ triceps on LUE \nconsistent with prior history. ___ LUE deltoid and ___ RUE and \nRLE. Sensation intact in upper and lower extremities. Unable to \nelicit upper extremity reflexes, patellar reflex symmetric b/l.', 'diagnoses': [{'icd_code': '81511', 'desc': 'Open fracture of base of thumb [first] metacarpal'}, {'icd_code': '81415', 'desc': 'Open fracture of trapezium bone [larger multangular] of wrist'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'E9201', 'desc': 'Accidents caused by other powered hand tools'}, {'icd_code': 'E0169', 'desc': 'Other activity involving property and land maintenance, building and construction'}, {'icd_code': 'E8499', 'desc': 'Accidents occurring in unspecified place'}], 'summary': "___ 06:55PM BLOOD WBC-6.9 RBC-4.21 Hgb-11.3* Hct-35.7* \nMCV-85 MCH-26.8* MCHC-31.6 RDW-15.5 Plt ___\n___ 06:55AM BLOOD WBC-5.4 RBC-3.82* Hgb-10.7* Hct-32.9* \nMCV-86 MCH-28.0 MCHC-32.5 RDW-15.8* Plt ___\n___ 05:25AM BLOOD WBC-5.8 RBC-3.84* Hgb-10.5* Hct-32.0* \nMCV-83 MCH-27.3 MCHC-32.9 RDW-15.3 Plt ___\n___ 06:55PM BLOOD Neuts-73.5* ___ Monos-2.7 Eos-1.1 \nBaso-0.3\n___ 06:55PM BLOOD ___ PTT-31.4 ___\n___ 06:55AM BLOOD ___ PTT-38.5* ___\n___ 05:25AM BLOOD ___ PTT-39.1* ___\n___ 05:25AM BLOOD Plt ___\n___ 06:55PM BLOOD Glucose-212* UreaN-27* Creat-1.3* Na-139 \nK-4.0 Cl-103 HCO3-25 AnGap-15\n___ 06:55AM BLOOD Glucose-96 UreaN-21* Creat-0.9 Na-145 \nK-3.3 Cl-108 HCO3-30 AnGap-10\n___ 05:25AM BLOOD Glucose-68* UreaN-15 Creat-0.9 Na-144 \nK-3.2* Cl-108 HCO3-28 AnGap-11\n___ 06:55PM BLOOD ALT-31 AST-49* CK(CPK)-1118* AlkPhos-95 \nTotBili-0.2\n___ 06:55AM BLOOD CK(CPK)-759*\n___ 09:20PM BLOOD CK(CPK)-717*\n___ 05:25AM BLOOD CK(CPK)-572*\n___ 06:55PM BLOOD CK-MB-13* MB Indx-1.2\n___ 06:55PM BLOOD cTropnT-0.06*\n___ 06:55AM BLOOD CK-MB-9 cTropnT-0.04*\n___ 09:20PM BLOOD CK-MB-10 MB Indx-1.4 cTropnT-0.04*\n___ 05:25AM BLOOD CK-MB-8 cTropnT-0.03*\n___ 06:55PM BLOOD Calcium-8.9 Phos-3.1 Mg-1.8\n___ 05:25AM BLOOD Calcium-8.2* Phos-3.4 Mg-1.8\n___ 07:00PM BLOOD Glucose-201* K-3.8\n\nECG (___)- Normal sinus rhythm, rate 60. Occasional \nventricular premature beat. Minor non-specific lateral \nrepolarization changes. Compared to the previous tracing of \n___ ventricular ectopy is new. \n\nChest X-Ray (___)- IMPRESSION: Borderline cardiac \nenlargement, stable from prior, without evidence of CHF or \npneumonia. \n\nCT Head w/o contrast (___)- IMPRESSION: \n1. No acute intracranial abnormality. \n2. Right maxillary and ethmoid sinus disease. \n\nSTRESS TEST (___)- Pharmacologic\nINTERPRETATION: This ___ year old type 2 IDDM woman with a PMH of \nMI \nwas referred to the lab for evaluation of chest pain. The \npatient was \ninfused with 0.142 mg/kg/min of dipyridamole over 4 minutes. No \narm, \nneck, back or chest discomfort was reported by the patient \nthroughout \nthe study. There were no significant ST segment changes during \nthe \ninfusion or in recovery. The rhythm was sinus with frequent \nisolated \napbs including intermittent couplets; and frequent vpbs. \nAppropriate \nhemodynamic response to the infusion. The dipyridamole was \nreversed \nwith 125 mg of aminophylline IV. \nIMPRESSION: No anginal type symptoms or ischemic EKG changes. \nAtrial \nand ventricular ectopy as outlined. Nuclear report sent \nseparately. \n\nCardiac perfusion study ___: Normal myocardial perfusion. \nThe calculated LVEF is 59%. \n#. Chest pressure: Patient's chest pain resolved after receiving \nSL nitro and aspirin in the ED. Concern is for ischemia given \npatient's cardiac history (MI in ___. While here, she was \nruled out for MI. EKG was unchanged and cardiac enzymes \nremained negative x 3. She remained chest-pain free while here. \n Given similarity to prior MI, we performed pharmacologic stress \ntest during this admission. There were no ischemic changes and \nEF was 59%. We continued to hold the patient's statin given \nelevated CK's on admission (see below). Upon discharge, patient \nwas hemodynamically stable and chest-pain free. \n\n#. Dizziness: Most likely is secondary to dehydration due to \nincreasing her lasix dose in recent days. Patient reports \ndizziness on standing. While here, she received gentle IV \nfluids and responded well. There were no episodes of dizziness \nreported while in the hospital, including during ambulation. \n___ was negative in the ED. CT head did not show any \nacute intracranial process. Dizziness resolved after IV fluids. \n ___ worked well with physical therapy. Lasix dose was decreased \nto 40mg daily.\n\n#. Emesis: In the setting of feeling dizzy likely a normal \nresponse. No other signs or symptoms of viral gastroenteritis. \nNo nausea and vomiting while in hospital. \n\n#. Acute Renal Failure: Creatinine up to 1.3 on admission. \nEtiology was pre-renal in the setting of increased lasix dose as \noutpatient. She was given IV fluids, Lasix dose was decreased. \nCreatinine was 0.9 on discharge. \n\n#. A-fib: Patient remained in sinus with PVCs while here. \nHowever, INR was elevated (4.1-->5.2) so patient's coumadin was \nheld. INR was down to 5.0 on discharge. Patient takes 6mg six \ndays a week and 8mg once a week (2mg tablets). Given high INR, \npatient was told to hold dose on day of discharge and following \nday. She is to get lab drawn on ___ and have results faxed to \nPCP to determine plan for resuming coumdin.\n\n#. Gout: Stable, no evidence of flare. She was previosuly on \ncolchicine which was recently discontinued secondary to \nworsening myopathy. She is not on allopurinol- only on \nprednisone 2.5mg daily for her myopathy. \n \n#. HTN: Patient had mildly elevated BP's while here. As an \noutpatient, her nifedipine was recently discontinued due to \nincreased ankle swelling. Given BP readings, and history of CAD \nand recent chest pain, she was started on amlodipine and this \nwas titrated to 10mg with improvement in her BP. She was \ncontinued on home doses of diovan and carvedilol. Her dose of \nlasix was decreased to 40mg daily (it was recently increased to \n60mg daily) due to dehydration. Nifedipine was held and she was \ninstructed not to resume taking it. \n\n#. Diabetes: Continued on outpatient insulin regemin and sliding \nscale. \n\n#. Myopathy: CK's elevated on admission. Up to 1118. Trended \ndown well with IV fluids (down to 572 on discharge). Patient \nhas had diagnosis for quite some time. Unclear etiology but \nseems stable. Per records, it improved when she was off of her \ncolchicine. Some of her weakness is related to old CVA. \nRecommend further work up as outpatient with possible biopsy if \nthis does not resolve. "}}
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{'final_diagnoses': ['Dehydration, hypertension', 'Coronary artery disease, paroxysmal atrial \nfibrillation'], 'procedures': ['None'], 'visit_summary': "#. Chest pressure: Patient's chest pain resolved after receiving \nSL nitro and aspirin in the ED. Concern is for ischemia given \npatient's cardiac history (MI in ___. While here, she was \nruled out for MI. EKG was unchanged and cardiac enzymes \nremained negative x 3. She remained chest-pain free while here. \n Given similarity to prior MI, we performed pharmacologic stress \ntest during this admission. There were no ischemic changes and \nEF was 59%. We continued to hold the patient's statin given \nelevated CK's on admission (see below). Upon discharge, patient \nwas hemodynamically stable and chest-pain free. \n\n#. Dizziness: Most likely is secondary to dehydration due to \nincreasing her lasix dose in recent days. Patient reports \ndizziness on standing. While here, she received gentle IV \nfluids and responded well. There were no episodes of dizziness \nreported while in the hospital, including during ambulation. \n___ was negative in the ED. CT head did not show any \nacute intracranial process. Dizziness resolved after IV fluids. \n ___ worked well with physical therapy. Lasix dose was decreased \nto 40mg daily.\n\n#. Emesis: In the setting of feeling dizzy likely a normal \nresponse. No other signs or symptoms of viral gastroenteritis. \nNo nausea and vomiting while in hospital. \n\n#. Acute Renal Failure: Creatinine up to 1.3 on admission. \nEtiology was pre-renal in the setting of increased lasix dose as \noutpatient. She was given IV fluids, Lasix dose was decreased. \nCreatinine was 0.9 on discharge. \n\n#. A-fib: Patient remained in sinus with PVCs while here. \nHowever, INR was elevated (4.1-->5.2) so patient's coumadin was \nheld. INR was down to 5.0 on discharge. Patient takes 6mg six \ndays a week and 8mg once a week (2mg tablets). Given high INR, \npatient was told to hold dose on day of discharge and following \nday. She is to get lab drawn on ___ and have results faxed to \nPCP to determine plan for resuming coumdin.\n\n#. Gout: Stable, no evidence of flare. She was previosuly on \ncolchicine which was recently discontinued secondary to \nworsening myopathy. She is not on allopurinol- only on \nprednisone 2.5mg daily for her myopathy. \n \n#. HTN: Patient had mildly elevated BP's while here. As an \noutpatient, her nifedipine was recently discontinued due to \nincreased ankle swelling. Given BP readings, and history of CAD \nand recent chest pain, she was started on amlodipine and this \nwas titrated to 10mg with improvement in her BP. She was \ncontinued on home doses of diovan and carvedilol. Her dose of \nlasix was decreased to 40mg daily (it was recently increased to \n60mg daily) due to dehydration. Nifedipine was held and she was \ninstructed not to resume taking it. \n\n#. Diabetes: Continued on outpatient insulin regemin and sliding \nscale. \n\n#. Myopathy: CK's elevated on admission. Up to 1118. Trended \ndown well with IV fluids (down to 572 on discharge). Patient \nhas had diagnosis for quite some time. Unclear etiology but \nseems stable. Per records, it improved when she was off of her \ncolchicine. Some of her weakness is related to old CVA. \nRecommend further work up as outpatient with possible biopsy if \nthis does not resolve. ", 'medications_prescribed': ['1. Carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times \na day).', '2. Insulin Sliding Scale\nPlease resume your humalog insulin sliding scale as your were \ntaking it at home', '3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '4. Prednisone 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).', '5. Valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', '6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '7. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '9. Outpatient Lab Work\nPlease get your INR and potassium checked on ___. There is an \norder in our computer system at ___ for this lab work.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 68, 'gender': 'M', 'symptoms': 'Cough/Dyspnea', 'medical_history': ['- Metastatic renal cell cancer ', '- Stage I rectal adenocarcinoma s/p resection in ___ at age ___', '- ___ CHF/Cardiomyopathy- per patient cardiologist felt \nrelated to viral infection. No further follow up ', '- HTN', '- Skin cancer', '- Iron deficiency anemia', '- Hypothyroidism', '- Hemachromatosis carrier'], 'family_history': '(obtained from previous records - patient notes quite a\nfew family members with cancer. Only 1st degree family member is\nsister with ___ cancer and father with prostate cancer) \nSister - ___ cancer at ___\nMaternal Uncle - ___ cancer at ___, passed away at ___ \nMaternal Aunt - Cancer, unknown primary passed away in ___ \nMaternal Aunt - ___ or ovarian cancer dx ___, died at ___ \nMaternal Aunt - Lung cancer at ___, ___ cancer at ___, breast\ncancer at ___, passed away at ___ \nMaternal Uncle - ___ at ___, passed away at ___ \nMaternal Aunt - ___ cancer at ___, passed away at ___ \nMaternal Uncle - ___ cancer at ___, now ___ \nMaternal Aunt - Cancer, unknown primary at ___, died at ___ \nMaternal Aunt - ___ cancer at ___, now ___ \nFour maternal first cousins - ___ cancer in their ___\nMaternal first cousin - ___ cancer at ___, Now ___ \nFather - ___ cancer at ___\nPaternal Grandmother - Cancer, unknown primary at ___, died ___ \nPaternal Grandfather - Lung cancer at ___, died at ___ ', 'present_illness': 'As per HPI in H&P by Dr. ___ ___:\n"Ms ___ is a ___ yo F with metastatic renal cell carcinoma\ns/p nephrectomy ___ years) initially treated at outside facility,\nnow on Clinical trial ___ with Nivolumab who presents from\nclinic-->ED with new dyspnea on exertion and RLE swelling. She\npresented to her outpatient oncologist appointment to receive \nher\n2nd dose of Nivolumab, but due to increase in dyspnea and RLE\nswelling was sent to the ED for evaluation. Patient notes\nincreased dyspnea over the last few weeks. No increase cough. \nShe\nworks in an ___ and notes that even after reading a\nstory recently she has had dyspnea. Does cough up some sputum\nafter nebulization treatments, but never bloody or purulent. She\nnotes no fever/chills. \n\nRLE swelling has occurred over the last ___ days. She notes no\npain, but does have some fullness in the back of her right knee\narea. Denies any pain or trauma to leg. "', 'medications': [{'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Creon 12', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QIDWMHS', 'doses_per_24_hrs': 4.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '257', 'valuenum': 257.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.02', 'valuenum': 3.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\nVS: ___ 1242 BP: 110/78 HR: 98 RR: 18 O2 sat: 96% O2\ndelivery: RA Dyspnea: 1 RASS: 0 Pain Score: ___\nGen: Cooperative. NAD\nHEENT: Moist oral mucosa. No JVD\nCV: RRR, soft systolic murmur LLSB\nResp: Course inspiratory noise throughout. Good airmovement. No\nreduced air sounds. \nAbd: Soft, NT, ND\nMSK: Right lower extremity swelling compaired to left. No \npitting\nedema\nPsych: Appropriate\nNeuro: Non focal. Gait WNL. \n\nDISCHARGE EXAM:\nVS: T 98.1, HR 100, BP 114/79, RR 16, SpO2 95% on RA\nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. \nOropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD.\nRESP: Coarse rhonchi and crackles bilaterally\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present.\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, fingertip RLE edema, mild tenderness to \npalpation behind right knee\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI,\nspeech fluent, moves all limbs\nPSYCH: pleasant, appropriate affect', 'diagnoses': [{'icd_code': 'K830', 'desc': 'Cholangitis'}, {'icd_code': 'C259', 'desc': 'Malignant neoplasm of pancreas, unspecified'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'E8342', 'desc': 'Hypomagnesemia'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'N400', 'desc': 'Benign prostatic hyperplasia without lower urinary tract symptoms'}, {'icd_code': 'E806', 'desc': 'Other disorders of bilirubin metabolism'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': "ADMISSION LABS:\n___ 01:35PM BLOOD WBC-6.8 RBC-3.48* Hgb-9.7* Hct-31.0* \nMCV-89 MCH-27.9 MCHC-31.3* RDW-16.1* RDWSD-52.8* Plt ___\n___ 01:35PM BLOOD Glucose-122* UreaN-12 Creat-0.7 Na-141 \nK-4.3 Cl-103 HCO3-23 AnGap-15\n___ 01:35PM BLOOD Albumin-3.6 Calcium-8.9\n___ 01:35PM BLOOD ALT-6 AST-10 AlkPhos-61 TotBili-0.4\n\nIMAGING:\nCTA chest (___):\nIMPRESSION: \n1. No evidence of pulmonary embolism or aortic abnormality. \n2. Large left pleural effusion, perhaps minimally enlarged \nsince prior. \n3. Scattered patchy opacities in the right lower lobe likely \nrepresent areas of pneumonia. \n4. There is persistent collapse of the left upper lobe. \nHowever, as this \narea demonstrates heterogeneous enhancement and is contiguous \nwith the soft tissue density encasing the left mainstem bronchus \nand branches of the left pulmonary vein, superimposed tumor \ncannot be excluded. \n5. Mucous plugging and atelectasis resulting in partial right \nlower lobe \ncollapse. \n6. Significant interval decrease in size of the dominant \nmediastinal \nconglomerate adenopathy as well as in supraclavicular, hilar and \nmediastinal lymphadenopathy. \n7. Interval improvement in left lower lobe aeration. \n8. Spleen is top-normal in size. \n\nRLE Doppler US (___):\nIMPRESSION: \n1. No evidence of deep venous thrombosis in the right lower \nextremity veins. \n2. Heterogeneous collection measuring up to 6.1 cm in the right \npopliteal \nfossa likely represents a complex/hemorrhagic, and potentially \nruptured, ___ cyst. \n\nDISCHARGE LABS:\n___ 05:25AM BLOOD WBC-4.4 RBC-3.43* Hgb-9.6* Hct-30.9* \nMCV-90 MCH-28.0 MCHC-31.1* RDW-16.2* RDWSD-53.8* Plt ___\n___ 05:25AM BLOOD Glucose-94 UreaN-12 Creat-0.7 Na-143 \nK-4.2 Cl-103 HCO3-26 AnGap-14\n___ 05:25AM BLOOD Calcium-9.1 Mg-1.9\nSummary: \n\n# Dyspnea on exertion\n# RLE edema\n# Renal cell carcinoma, metastatic to the lung\nMs ___ is a ___ yo F with metastatic renal cell carcinoma \n(mets to the lung) s/p nephrectomy ___ years ago) now being \ntreated with nivolumab and recent hospitalization (___) for \nIJ DVT and subsegmental PE on Lovenox as well as enlarging L \nhilar mass causing airway obstruction and L pleural effusion s/p \nAPC and stent placement, and recent (___) treatemt for \npost-obstructive pneumonia requiring bronchoscopy for toileting \nwho presented with RLE edema and shortness of breath, found to \nhave a recurrent L sided pleural effusion and a new RML opacity \non imaging. CTA did not show any evidence of PE and she was \nalready being anticoagulated on Lovenox. She did not have any \nfever/chills/leukocytosis, although is immunocompromised. She \nwas not started on antibiotics. Interventional pulmonology was \nconsulted. They did not feel that the left pleural effusion \nwould be amenable to drainage given the small size. Her \nrespiratory symptoms improved and she returned to her baseline \nafter she received nebulizers and mucolytics. \nShe had a RLE Doppler US that did not show evidence of DVT - it \nwas most consistent with a ruptured ___ cyst. The patient \nfelt that the swelling and pain in her RLE had improved \nsignificantly the morning after admission.\nDr. ___ outpatient oncologist, was contacted and he \nagreed that because the patient felt she had returned to her \nbaseline, had no evidence of infection, and did not have a large \nleft pleural effusion that could be tapped, she could return \nhome with follow up as scheduled. \n\n# HTN - continued home Metoprolol\n# Anemia - stable\n# Hypothyroidism - Continued home Levothyroxine\n\n>30 minutes were spent on this patient's complex discharge"}}
|
{'final_diagnoses': ['Shortness of breath likely ___ mucous plugging', 'Recurrent left pleural effusion', 'RML opacity', 'Ruptured ___ cyst'], 'procedures': ['None'], 'visit_summary': "Summary: \n\n# Dyspnea on exertion\n# RLE edema\n# Renal cell carcinoma, metastatic to the lung\nMs ___ is a ___ yo F with metastatic renal cell carcinoma \n(mets to the lung) s/p nephrectomy ___ years ago) now being \ntreated with nivolumab and recent hospitalization (___) for \nIJ DVT and subsegmental PE on Lovenox as well as enlarging L \nhilar mass causing airway obstruction and L pleural effusion s/p \nAPC and stent placement, and recent (___) treatemt for \npost-obstructive pneumonia requiring bronchoscopy for toileting \nwho presented with RLE edema and shortness of breath, found to \nhave a recurrent L sided pleural effusion and a new RML opacity \non imaging. CTA did not show any evidence of PE and she was \nalready being anticoagulated on Lovenox. She did not have any \nfever/chills/leukocytosis, although is immunocompromised. She \nwas not started on antibiotics. Interventional pulmonology was \nconsulted. They did not feel that the left pleural effusion \nwould be amenable to drainage given the small size. Her \nrespiratory symptoms improved and she returned to her baseline \nafter she received nebulizers and mucolytics. \nShe had a RLE Doppler US that did not show evidence of DVT - it \nwas most consistent with a ruptured ___ cyst. The patient \nfelt that the swelling and pain in her RLE had improved \nsignificantly the morning after admission.\nDr. ___ outpatient oncologist, was contacted and he \nagreed that because the patient felt she had returned to her \nbaseline, had no evidence of infection, and did not have a large \nleft pleural effusion that could be tapped, she could return \nhome with follow up as scheduled. \n\n# HTN - continued home Metoprolol\n# Anemia - stable\n# Hypothyroidism - Continued home Levothyroxine\n\n>30 minutes were spent on this patient's complex discharge", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild', 'Acetylcysteine 20% ___ mL NEB TID', 'albuterol sulfate 2.5 mg /3 mL (0.083 %) inhalation TID', 'Enoxaparin Sodium 80 mg SC Q12H', 'GuaiFENesin ER 1200 mg PO Q12H', 'Ipratropium Bromide MDI 2 PUFF IH QID', 'Ipratropium Bromide MDI 2 PUFF IH QID', 'Levothyroxine Sodium 75 mcg PO DAILY', 'Metoprolol Succinate XL 100 mg PO DAILY', 'nystatin 100,000 unit/gram topical BID', 'Sodium Chloride 3% Inhalation Soln 15 mL NEB BID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': 'abdominal pain, headache, generalized weakness', 'medical_history': ['Workup:', '___ Pap NIL ', '___ Pap NIL', '___ Pap LSIL, question HSIL', ' Cervical biopsy CIN 2', ' LEEP CIN-3, positive endocervical and exocervical margins', '___ through ___ Paps NIL ___ negative HPV)', '___ NIL pap, +HR HPV, +HPV 16', '___ ASC-H pap, neg HR HPV', " cervical bx 1, 10 o'clock CIN ___", ' ECC AIS, CIN3', "OBHx: Admits to ___ pregnancies with ___ TAB's. 2 spontaneous\nvaginal deliveries.", 'GYNHx:', '-Menarche at ___', '-Menses: regular w/ moderate bleeding ', '-No h/o STIs', '-Current contraception: none ', 'MedHx: denies', 'SurgHx: LEEP, CKC'], 'family_history': None, 'present_illness': 'Ms. ___ is a ___ now ___ s/p cold knife conization of \nthe cervix for AIS c/b postop vaginal bleeding s/p OR takeback \nfor EUA. Total EBL was 225cc. Pt reports that since her surgery, \nshe has had worsening abdominal pain and also reports a \nworsening headache. She reports generally feeling weak. She \ndenies any F/C, no CP/SOB, no lightheadedness/dizziness. She \ndoes report some nausea and di have an episode of emesis in the \nED requiring reglan. She also had an episode of diarrhea today. \nShe denies any vaginal bleeding since the procedure, no foul \nsmelling discharge, and has remained on strict pelvic rest. She \ndenies any dysuria. She has received 1 dose of Tylenol in the \nED.', 'medications': [{'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenazopyridine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Escitalopram Oxalate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'AmLactin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '489', 'valuenum': 489.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SM .'}, {'value': '17', 'valuenum': 17.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.018', 'valuenum': 1.018, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Cloudy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '>182*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MOD.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '399', 'valuenum': 399.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 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'34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77.2', 'valuenum': 77.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '547', 'valuenum': 547.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70.3', 'valuenum': 70.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '531', 'valuenum': 531.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 47 if non African-American (mL/min/1.73 m2). Estimated GFR = 57 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical Exam on day of discharge:\n\nGeneral: uncomfortable\nCardiac: RRR\nPulmonary: CTAB, no w/r/r\nAbdomen: soft, non-disteneded, TTP throughout, voluntary \nguarding\nin LLQ, no rebound or involuntary guarding\nGU: minimal spotting\nExtremities: WWP, calves nontender, pboots on', 'diagnoses': [{'icd_code': '5750', 'desc': 'Acute cholecystitis'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '6181', 'desc': 'Uterine prolapse without mention of vaginal wall prolapse'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4011', 'desc': 'Benign essential hypertension'}, {'icd_code': '29590', 'desc': 'Unspecified schizophrenia, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '4439', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': '___ 06:28AM WBC-16.4* RBC-2.60* HGB-7.5* HCT-23.2* MCV-89 \nMCH-28.8 MCHC-32.3 RDW-15.3 RDWSD-49.9*\n___ 06:28AM PLT COUNT-141*\n___ 07:05PM URINE HOURS-RANDOM\n___ 07:05PM URINE UCG-NEGATIVE\n___ 07:05PM URINE COLOR-Straw APPEAR-Hazy* SP ___\n___ 07:05PM URINE BLOOD-SM* NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-10* BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-MOD*\n___ 07:05PM URINE RBC-1 WBC-2 BACTERIA-FEW* YEAST-NONE \nEPI-5\n___ 07:05PM URINE MUCOUS-RARE*\n___ 05:52PM LACTATE-1.0\n___ 05:35PM GLUCOSE-116* UREA N-8 CREAT-0.7 SODIUM-142 \nPOTASSIUM-3.4* CHLORIDE-107 TOTAL CO2-24 ANION GAP-11\n___ 05:35PM estGFR-Using this\n___ 05:35PM ALT(SGPT)-<5 AST(SGOT)-14 ALK PHOS-56 TOT \nBILI-0.6\n___ 05:35PM LIPASE-22\n___ 05:35PM ALBUMIN-3.9\n___ 05:35PM WBC-13.9* RBC-2.11* HGB-6.2* HCT-20.2* MCV-96 \nMCH-29.4 MCHC-30.7* RDW-13.4 RDWSD-47.1*\n___ 05:35PM NEUTS-77.1* LYMPHS-11.9* MONOS-9.6 EOS-0.2* \nBASOS-0.4 IM ___ AbsNeut-10.74* AbsLymp-1.66 AbsMono-1.33* \nAbsEos-0.03* AbsBaso-0.05\n___ 05:35PM PLT COUNT-145*\n___ 05:35PM ___ PTT-24.3* ___\n___ 10:40AM WBC-9.1 RBC-1.82* HGB-5.3* HCT-17.2* MCV-95 \nMCH-29.1 MCHC-30.8* RDW-13.6 RDWSD-46.2\n___ 10:40AM PLT COUNT-127*\nMs. ___ was admitted to the gynecologic oncology service \nfor postoperative pain and weakness after same day discharge \nfrom a cold knife cone with OR takeback for vaginal bleeding. \nHer Hct was noted to by 17.3 and then subsequently 20.2. She \nreceived 2 units of packed RBCs with Hct rising to 23.2, and \nthen received another 2 units. Her Hct rose to 28.7. A pelvic \nultrasound showed a moderate amount of complex fluid within the \ncervical canal, mod-large complex fluid w/n pelvis. CTA A/P \n(___) showed extensive hemorrhage throughout abdomen and pelvis \nand increased density posterior to cervix, no e/o active \nextravasation, uterine fibroids. She was given tylenol and \nibuprofen for her pain which improved during her admission. She \ncontinued to void on her own without issues.\n\nBy hospital day 2, her Hct had improved and her symptoms had \nimproved. She was discharged home in stable condition with \noutpatient follow-up scheduled.'}}
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{'final_diagnoses': ['Hemoperitoneum'], 'procedures': ['Blood transfusion'], 'visit_summary': 'Ms. ___ was admitted to the gynecologic oncology service \nfor postoperative pain and weakness after same day discharge \nfrom a cold knife cone with OR takeback for vaginal bleeding. \nHer Hct was noted to by 17.3 and then subsequently 20.2. She \nreceived 2 units of packed RBCs with Hct rising to 23.2, and \nthen received another 2 units. Her Hct rose to 28.7. A pelvic \nultrasound showed a moderate amount of complex fluid within the \ncervical canal, mod-large complex fluid w/n pelvis. CTA A/P \n(___) showed extensive hemorrhage throughout abdomen and pelvis \nand increased density posterior to cervix, no e/o active \nextravasation, uterine fibroids. She was given tylenol and \nibuprofen for her pain which improved during her admission. She \ncontinued to void on her own without issues.\n\nBy hospital day 2, her Hct had improved and her symptoms had \nimproved. She was discharged home in stable condition with \noutpatient follow-up scheduled.', 'medications_prescribed': ['1. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN Pain - Mild \n\n\nRX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg ___ tab-cap \nby mouth every eight (8) hours prn Disp #*12 Capsule Refills:*0 ', '2. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever \nRX *acetaminophen 500 mg ___ tablet(s) by mouth q6h prn Disp \n#*60 Tablet Refills:*0 ', '3. Ondansetron 4 mg PO Q8H:PRN Nausea/Vomiting - First Line \nRX *ondansetron 4 mg ___ tablet(s) by mouth q8h prn Disp #*8 \nTablet Refills:*0 ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 31, 'gender': 'F', 'symptoms': 'Altered mental status.', 'medical_history': ['#HIV/AIDS: Dx ___. Last genotype (___) without major PR/RT \nmutations. Poor tolerance of Sustiva ___ psych issues. Prior \nregimens include LPV/r and TDF/FTC. Evaluated most recently in \n___ with plan to start ___ darunavir/ritonavir + Truvada. \nSocial support was JRI (SW ___ ___, ___ and \nCounselor ___ ___, ___, AIDS Action, \n___ support. ID note from ___ states patient was \nrequesting PACT though unclear f/u. \n.\nCD4 Trend\n(___): 286 (19%), VL >100K\n(___): 307 (16.5%), VL >100K\n(___): 275 (19%), VL PENDING\n.\nSerologies (___):\nCMV+, Toxo IgG -, Hep B SAb +, SAg -, CAb +. RPR nr (negative in \n___. \n.\nHx Anal HSV, responsive to ACV.', '.', '#Hepatitis C: Genotype 1a. VL was 7million (___) with biopsy \n(___) showing mildly active heptatis and ___ fibrosis. \nTreatment deferred pending Psych issues.', '.', '#Psych: Dx of Bipolar D/O, PTSD, Substance Abuse. Prior Rx hx:\n--BPAD: Lithium, Depakote\n--ADD: Stimulants\n--Depression: Prozac, Zoloft\n--Insomnia: Trazadone, Ambien\n--Psychotic syptoms: Seroquel, Zyprexa ', '.', '#Recurrent DVT, PE s/p IVC Filter (___)\n--seen by ___ Heme/Onc (___) who recommended no \nanti-coagulation given ___ hx of clot-free episodes\n--DVT x2 (___), yr he was dx with HIV, unprovoked\n--c/o ___ edema (evaluated by ___ Vascular, with duplex studies \nshowing no e/o venous valvular incompetence)\n--Hypercoag w/u was comprehensively negative\nPTT-LA, lupus anti-coagulant, ATIII, Protein C, APC, Protein S, \n___ 2010A mutation, FVL, Homocysteine all normal', '.', '#Sleep Apnea: recommended CPAP, not used', '.', '#H/o Rectal Herpes; responsive to ACV', '.', '#TIIDM: \n--dx in ___, had been on Lantus 50U sc QHS w/o pre-prandial \ninsulin (Hgb A1C was 6.6 in ___\n--was on ACEI, Metformin 1000 BID as recently as ___\n--Normal ophtho exam in ___ ', '.', '#CAD: Evalauted 3x in last yr for UA sx. Returned most recently \nto ___ ED with pleuritic CP sx.\n--Adeno-MIBI (___): Negative for ischemia. Equivocal \ninferior/inferolateral ischemia (reversible at rest) with \ntransient ischemic diltation, LVEF was 59% with normal wall \nmotion.\n--Cardiac CTA (___): Mixed plaque in proximal LAD, focal \nplaque in proximal ___ diagnosal branch. Cardiac cath was \nrecommnded. Patient was admitted for cath 2x and left AMA each \ntime. \n--Rx Regimen (___) was Pravastatin 10mg ___, Atenolol 25mg ___, \nLisinopril 10mg ___ 325 ___'], 'family_history': 'Does not recall any significant FH. Adopted. ', 'present_illness': '___ hx HIV/AIDS (hx oral thrush, unclear hx prior OIs; not on Rx \nx2mo), CAD, h/o recurrent DVT, PE s/p IVC Filter ___ not on \nanti-coagulation), and untreated HepC found confused on park \nbench. \n.\nPatient describes 2mo hx of worsening memory, confusion, word \nfinding difficulty. Further notes similar time course of \nbilateral ___ weakness/parasthesia. More recently, patient \ndescribes 2wk hx of asymmetric R-sided weakness (predominantly \nof the RUE) and "numbness" of the RUE/RLE. Additionally provides \n___ hx of diarrhea (non-bloody, occasionaly mucoid) a/w \nanorexia, decreased po intake though no N/V. Finally, patient \nnotes 1wk hx occasionally productive cough (yellow-green, not \nbloody). ROS notable for +chills, rhinorrhea, no sore throat, no \noral ulcers. + neck pain, occasional h/a. Denies recent thrush. \n+ chest tightness, occasional SOB. No abdominal pain, + \ndiarrhea, no dysuria, or other changes in bowel/bladder habits. \nNo new rashes, no arthralgias. Unclear weight loss hx. \n.\nPatient was evaluated in the ED. VS were 99.7, 69, 138/80, 20, \n100% RA. CXR was clear. Bld Cx Pending. He was given 2g Cftx, 1g \nVancomycin for empiric meningitis coverage. LP with Opening \npressure of 15, 1 WBC (Diff 82L, ___, 0 RBC, TP 40, Glucose 64.\n.\n10 point review of systems otherwise negative except as noted \nabove.', 'medications': [{'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Methylene Blue 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'EXAM ON ADMISSION\nVS: T 97.7 HR 69BP 138/80 RR 20 Sat 100 % RA\nGen: Awake and alert/oriented, slow to answer questions\nEye: extra-occlar movements intact, pupils equal round, reactive \nto light, sclera anicteric, not injected, no exudates\nENT: Edentulous, MM dry\nNeck: no LAD\nCardiovascular: regular rate and rhythm, normal s1, s2, no \nmurmurs, rubs or gallops\nRespiratory: Clear to auscultation bilaterally, scattered \nwheezes, rales or rhonchi\nAbd: Soft, mild diffuse tenderness, + BS no rebound or guarding, \nno HSM\nExtremities: 1+ DP pulses, poor hygeine\nNeurological:\nAwake and alert but slow to respond. CN II-XII intact. Upper \next: 3+/5 bilat with R wrist drop. Lower ext with 3+/5 bilat. \nPoor effort overall. Tone normal to slightly decreased. No \nasterixis. Gait not assessed.', 'diagnoses': [{'icd_code': 'E6601', 'desc': 'Morbid (severe) obesity due to excess calories'}, {'icd_code': 'E559', 'desc': 'Vitamin D deficiency, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z6843', 'desc': 'Body mass index [BMI] 50.0-59.9, adult'}, {'icd_code': 'E780', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'L709', 'desc': 'Acne, unspecified'}, {'icd_code': 'K660', 'desc': 'Peritoneal adhesions (postprocedural) (postinfection)'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'L309', 'desc': 'Dermatitis, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'R000', 'desc': 'Tachycardia, unspecified'}, {'icd_code': 'R110', 'desc': 'Nausea'}], 'summary': 'CBC: WBC 4.0, hct 37.1, plt 122, mcv 88; neut: 51.6%, lymph \n37.1%\nElectrolytes: Na 138, K 3.5, cl 101, co2 25, bun 17, crt 0.9, \ngluc 103\nlactate 1.3, ammonia 15\nLFT\'s: AST 29, ALT 17, alk phos 44, t bili 0.9, albumin 3.6, cpk \n128\ntox: ___ neg, ethanol neg, tylenol neg, benzo neg, barbitrt neg, \ntca neg\nlipase 25\nCSF ___: protein 40, glucose 64, 1 WBC, 0 RBC, gram stain \nand culture pending\nBlood cultures pending ___\nUA ___ rbc, ___ wbc, protein 500, ketones 50, sm bili, \nurobili 8.\nUrine tox negative for Benzos, Barbs, Opiates, Cocaine, Amphet, \nMthdne\nLyme negative\nStool cx negative\n.\nChest xray ___: no acute process.\n.\nHead CT ___: no acute intracranial process.\n#Altered Mental Status: Initial concern was for primary CNS \ninfection. LP as noted with 1WBC, 0RBC. Patient was empirically \ncovered with Acyclovir x48h until viral cultures were \npreliminarily negative, though concern for HSV encephalitis was \nlow given LP findings. Additional infectious considerations \nincluded neuro-syphillis (RPR was non-reactive), Toxo (sera \nIgG/M negative), CMV (sera IgG/M negative), Cryptococcus (CRAG \nnegative). Additional altered mental status work-up included TSH \n(normal), Folate/B12 (normal), NH3 (15; normal). Toxic \ningestions were ruled out as well (negative urine and serum tox \nscreen). Given findings of ataxia, memory loss patient was \nstarte empirically on Thiamine for potential Wernicke\'s. \n.\nGiven otherwise negative work-up, primary consideration was \ngiven to HIV encephalopathy vs. HIV associated dementia. Patient \nwas evaluated by the ID service who felt the subacute memory \ndecline, psychomotor slowing could be consistent with HIV \nencephalopathy vs. HIV associated dementia. The patient\'s exam \nwas notable for impaired recent memory (e.g. no re-call of ___ \nPTA), psychomotor slowing, poverty of speech, and inattention. \nOn discharge, speech, attention, psychomotor slowing was \nmodestly improved though patient noted he was "still confused" \nparticularly regarding recent events. Additional work-up \nregarding the possibility of HIV associated neuro-cognitive \nchange (neuro-psych testing, MRI) was deferred to out-patient \nteam. Patient was re-started on HAART (see HIV below) after \ndiscussion with out-patient ID physician ___ Dr. ___ \nand with consultation with in-patient ID service. Though \nunlikely, the possibility of neurologic Lyme was raised as a \npotential mechanism for altered mental status and Lyme \nserologies were sent the day of discharge. \n.\n#HIV: Patient with ___ hx of intermittent HAART use. Following \ndiscussion with out-patient ID physician ___ ID Dr. ___ \n___, and with plan for interim subacute care facility \nmonitoring, HAART (Darunavir/r 800/100, Truvada 1 tab ___ was \nre-initiated. During the hospitalization T cell subsets were \nnotable for CD4 275 (19%), VL 474k. There was no indication to \ninitiate further HIV related prophylaxis.\n.\n#Neuro: Patient was evaluated by the Neurology service with \ndiffuse non-focal weakness. Possibility of polyneuropathy (HIV \nvs. DM vs. Syphillis) vs. mononeuritis multiplex (HIV vs. DM vs. \nMM/MGUS) vs. poly-radiculopathy was raised. Neurologic exam was \nnotable for R wrist drop, symmetric ___ weakness, distal \nsymmetric sensory loss in stocking-glove distribution, and \nasymmetric patellar reflex (L>R). Neurological deficits felt \nmost likely ___ known co-morbidities (i.e. HIV, DM). An SPEP was \nsent to r/o potential MGUS/MM though concern is relatively low. \nAn RPR returned non-reactive. Further evaluation was suggested \n(EMG) and was deferred to the out-patient setting. \n.\n#Psych: Patient was evaluated by the Psychiatry service during \nthe hospitalization (prior psych hx as noted above). On \nadmission, patient endorsed passive suicidal ideation (with no \nplan), and depressed mood. The Psychiatry impression included \nAxis I diagnoses of Bipolar d/o, unspecified, Cognitive d/o NOS, \nr/o secondary to HIV, Anxiety d/o NOS, and Alcohol dependence. \nThe possibility of underlying dementia substrate with \nsuperimposed delirium was suggested. Given the stability of \nmental status during hospital course, there was relatively low \nconcern for a superimposed delirious process and further \nevaluation (e.g. EEG) was deferred. Psychiatry felt that patient \nmay benefit from therapeutic management for mood, sleep, and \nappetite. Given risk for mania, anti-depressant medications were \nnot initiated during the hospitalization. Psychiatry suggested \npotential utility of Ritalin (inattention) and Remeron \n(depression, appetite). \n.\n#T2DM: Patient with prior diagnosis of TIIDM. Blood sugars \nranged from 150-300 during hospitalization. Patient received \nHumalog SS (required ___ during hospitalization. Hgb A1C \nwas 7.7. \n.\n#Nephropathy: Patient noted to have proteinuria on initial U/A \nwhich was felt to be ___ TIIDM vs. HIVAN. Lisinopril 10mg po ___ \nwas started during hospitalization.\n.\n#HepC: There was no transaminitis, normal Bilis, and no e/o \nhepatic synthetic dysfunction on admission. An AFP was checked \nand was normal (1.1). \n.\n#CAD: Patient has hx of UA with e/o of reversible ischemia on \nAdeno-MIBI (___) as well as Cardiac CTA (___) showing modest \nocclusion of proximal LAD, and modest occlusion of diagonal \ncoronary branches. A lipid panel was checked with TC 111, LDL \n62. Given hx TIIDM, patient was started on ___ 81mg, pravastatin \n10mg po ___. There were no episodes of chest pain during the \nhospitalization. \n.\n#Functional Status/ADLs: Patient was evaluated by ___. There \nwas concern for inability to carry out ADLs including ambulation \n___ polyneuropathy vs. mononeuritis multiplex) as well as \nfeeding (patient R-handed, with noted R wrist drop). \nRecommendation was for discharge to rehab facility for further \nevaluation and work with ___.'}}
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{'final_diagnoses': ['Primary Diagnoses:', 'HIV encephalopathy ', 'HIV associated dementia', 'Secondary Diagnoses:', 'Diabetes Mellitus', 'Coronary Artery Disease', 'Hepatitis C', 'Bipolar D/O', 'Anxiety D/O'], 'procedures': ['Lumbar puncture ___'], 'visit_summary': '#Altered Mental Status: Initial concern was for primary CNS \ninfection. LP as noted with 1WBC, 0RBC. Patient was empirically \ncovered with Acyclovir x48h until viral cultures were \npreliminarily negative, though concern for HSV encephalitis was \nlow given LP findings. Additional infectious considerations \nincluded neuro-syphillis (RPR was non-reactive), Toxo (sera \nIgG/M negative), CMV (sera IgG/M negative), Cryptococcus (CRAG \nnegative). Additional altered mental status work-up included TSH \n(normal), Folate/B12 (normal), NH3 (15; normal). Toxic \ningestions were ruled out as well (negative urine and serum tox \nscreen). Given findings of ataxia, memory loss patient was \nstarte empirically on Thiamine for potential Wernicke\'s. \n.\nGiven otherwise negative work-up, primary consideration was \ngiven to HIV encephalopathy vs. HIV associated dementia. Patient \nwas evaluated by the ID service who felt the subacute memory \ndecline, psychomotor slowing could be consistent with HIV \nencephalopathy vs. HIV associated dementia. The patient\'s exam \nwas notable for impaired recent memory (e.g. no re-call of ___ \nPTA), psychomotor slowing, poverty of speech, and inattention. \nOn discharge, speech, attention, psychomotor slowing was \nmodestly improved though patient noted he was "still confused" \nparticularly regarding recent events. Additional work-up \nregarding the possibility of HIV associated neuro-cognitive \nchange (neuro-psych testing, MRI) was deferred to out-patient \nteam. Patient was re-started on HAART (see HIV below) after \ndiscussion with out-patient ID physician ___ Dr. ___ \nand with consultation with in-patient ID service. Though \nunlikely, the possibility of neurologic Lyme was raised as a \npotential mechanism for altered mental status and Lyme \nserologies were sent the day of discharge. \n.\n#HIV: Patient with ___ hx of intermittent HAART use. Following \ndiscussion with out-patient ID physician ___ ID Dr. ___ \n___, and with plan for interim subacute care facility \nmonitoring, HAART (Darunavir/r 800/100, Truvada 1 tab ___ was \nre-initiated. During the hospitalization T cell subsets were \nnotable for CD4 275 (19%), VL 474k. There was no indication to \ninitiate further HIV related prophylaxis.\n.\n#Neuro: Patient was evaluated by the Neurology service with \ndiffuse non-focal weakness. Possibility of polyneuropathy (HIV \nvs. DM vs. Syphillis) vs. mononeuritis multiplex (HIV vs. DM vs. \nMM/MGUS) vs. poly-radiculopathy was raised. Neurologic exam was \nnotable for R wrist drop, symmetric ___ weakness, distal \nsymmetric sensory loss in stocking-glove distribution, and \nasymmetric patellar reflex (L>R). Neurological deficits felt \nmost likely ___ known co-morbidities (i.e. HIV, DM). An SPEP was \nsent to r/o potential MGUS/MM though concern is relatively low. \nAn RPR returned non-reactive. Further evaluation was suggested \n(EMG) and was deferred to the out-patient setting. \n.\n#Psych: Patient was evaluated by the Psychiatry service during \nthe hospitalization (prior psych hx as noted above). On \nadmission, patient endorsed passive suicidal ideation (with no \nplan), and depressed mood. The Psychiatry impression included \nAxis I diagnoses of Bipolar d/o, unspecified, Cognitive d/o NOS, \nr/o secondary to HIV, Anxiety d/o NOS, and Alcohol dependence. \nThe possibility of underlying dementia substrate with \nsuperimposed delirium was suggested. Given the stability of \nmental status during hospital course, there was relatively low \nconcern for a superimposed delirious process and further \nevaluation (e.g. EEG) was deferred. Psychiatry felt that patient \nmay benefit from therapeutic management for mood, sleep, and \nappetite. Given risk for mania, anti-depressant medications were \nnot initiated during the hospitalization. Psychiatry suggested \npotential utility of Ritalin (inattention) and Remeron \n(depression, appetite). \n.\n#T2DM: Patient with prior diagnosis of TIIDM. Blood sugars \nranged from 150-300 during hospitalization. Patient received \nHumalog SS (required ___ during hospitalization. Hgb A1C \nwas 7.7. \n.\n#Nephropathy: Patient noted to have proteinuria on initial U/A \nwhich was felt to be ___ TIIDM vs. HIVAN. Lisinopril 10mg po ___ \nwas started during hospitalization.\n.\n#HepC: There was no transaminitis, normal Bilis, and no e/o \nhepatic synthetic dysfunction on admission. An AFP was checked \nand was normal (1.1). \n.\n#CAD: Patient has hx of UA with e/o of reversible ischemia on \nAdeno-MIBI (___) as well as Cardiac CTA (___) showing modest \nocclusion of proximal LAD, and modest occlusion of diagonal \ncoronary branches. A lipid panel was checked with TC 111, LDL \n62. Given hx TIIDM, patient was started on ___ 81mg, pravastatin \n10mg po ___. There were no episodes of chest pain during the \nhospitalization. \n.\n#Functional Status/ADLs: Patient was evaluated by ___. There \nwas concern for inability to carry out ADLs including ambulation \n___ polyneuropathy vs. mononeuritis multiplex) as well as \nfeeding (patient R-handed, with noted R wrist drop). \nRecommendation was for discharge to rehab facility for further \nevaluation and work with ___.', 'medications_prescribed': ['1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale \nunit Subcutaneous ASDIR (AS DIRECTED): please see sliding scale.', '3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. Pravastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '6. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) \nunit Injection TID (3 times a day).', '7. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '8. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours) as needed for fever or pain.', '9. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet \nPO DAILY (Daily).', '10. Darunavir 400 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '11. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily).', '12. Cyanocobalamin 250 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily) for 1 weeks.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': 'left lower extremity stasis and swelling', 'medical_history': ['type 2 diabetes mellitus', 'history of kidney stones', 'diabetic retinopathy', 'obesity', 'dyslipidemia', 'hypertension', 'first metatarsal exostectomy, left foot (___)', 'left transmetatarsal amputation of the foot (___)', 'Right fourth \ntoe amputation (___)', 'Excision of osteomyelitis right third \ntoe (___)', 'Right femoral-DP bypass (___)', 'Left above-knee \npopliteal artery to DP artery bypass with non-reversed greater \nsaphenous vein, angioscopy and valve lysis (___)'], 'family_history': 'Non-contributory', 'present_illness': 'Mr. ___ is a ___ old Male who was seen in follow-up for \nbilateral popliteal to pedal bypass grafts. The was left \nperformed in ___ and the\nright in ___. He still has fairly significant leg swelling \nwith stasis-type changes primarily on the left. He has palpable \ngraft pulses. The graft pulse on the left is somewhat weaker \nthan the right. He has had his duplex showing the step-up in the \ndistal graft due to caliber change. This appears unchanged, \nhowever, the graft velocities in the upper graft are now slower\nand as low as 21. Because of this, I am concerned for the \npotential loss of this graft whether it is due to intimal \nhyperplasia or an anatomic change in caliber that was \npreexisting but more comfortable having arteriographic\nimaging. He was admitted following elective admission for left \nlower extremity angiography, which was diagnostic.', 'medications': [{'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxymetazoline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OSELTAMivir', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Guaifenesin-CODEINE Phosphate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Viscous 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '3X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.7,. Estimated GFR = 17 if non African-American (mL/min/1.73 m2). Estimated GFR = 20 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '169', 'valuenum': 169.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.77', 'valuenum': 2.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '479', 'valuenum': 479.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 23070.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 624.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SM .'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 79.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.68', 'valuenum': 2.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '126', 'valuenum': 126.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78.3', 'valuenum': 78.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.62', 'valuenum': 2.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 59.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'pg/mL', 'ref_range_lower': 15.0, 'ref_range_upper': 65.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.1', 'valuenum': 21.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.36', 'valuenum': 2.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.52', 'valuenum': 2.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.9,. Estimated GFR = 15 if non African-American (mL/min/1.73 m2). Estimated GFR = 19 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '228', 'valuenum': 228.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.55', 'valuenum': 2.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '240', 'valuenum': 240.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.58', 'valuenum': 2.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 44458.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 624.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '252', 'valuenum': 252.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.77', 'valuenum': 2.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '425', 'valuenum': 425.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VITALS: Afebrile, vital signs stable.\nHEENT: Normocephalic, atraumatic. EOMI. PERRL. Nares clear. \nMucous membranes moist. Neck supple without lymphadenopathy.\n___: Regular rate and rhythm, without murmurs, rubs or gallops. \nS1 and S2. No evidence of carotid bruits.\nRESP: Clear to auscultation bilaterally without adventitious \nsounds. No wheezing, rhonchi or crackles.\nABD: soft, non-tender, non-distended, with normoactive bowel \nsounds. No masses or peritoneal signs.\nEXTR: The right lower extremity is warm well-perfused and is \nwithout erythema, drainage or edema. The left lower extremity is \nwarm well-perfused and is without erythema, drainage; only mild \nedema.\nPULSE EXAM: Fem palp B; DP palp B; ___ dopp B', 'diagnoses': [{'icd_code': '4870', 'desc': 'Influenza with pneumonia'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '48242', 'desc': 'Methicillin resistant pneumonia due to Staphylococcus aureus'}, {'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '42843', 'desc': 'Acute on chronic combined systolic and diastolic heart failure'}, {'icd_code': '5854', 'desc': 'Chronic kidney disease, Stage IV (severe)'}, {'icd_code': '78729', 'desc': 'Other dysphagia'}, {'icd_code': '2930', 'desc': 'Delirium due to conditions classified elsewhere'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '9349', 'desc': 'Foreign body in respiratory tree, unspecified'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '49322', 'desc': 'Chronic obstructive asthma with (acute) exacerbation'}, {'icd_code': '2769', 'desc': 'Electrolyte and fluid disorders not elsewhere classified'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}, {'icd_code': '44020', 'desc': 'Atherosclerosis of native arteries of the extremities, unspecified'}, {'icd_code': '04149', 'desc': 'Other and unspecified Escherichia coli [E. coli]'}, {'icd_code': '7847', 'desc': 'Epistaxis'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': 'E915', 'desc': 'Foreign body accidentally entering other orifice'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': 'V1302', 'desc': 'Personal history, urinary (tract) infection'}], 'summary': "___ 06:50AM BLOOD WBC-6.2 RBC-4.95 Hgb-14.8 Hct-44.6 MCV-90 \nMCH-29.9 MCHC-33.2 RDW-13.6 Plt ___\nNEURO/PAIN: The patient was maintained on IV pain medication in \nthe immediate post-operative period and transitioned to PO \nnarcotic medication with adequate pain control on ___. The \npatient remained neurologically intact and without change from \nbaseline during their stay. The patient remained alert and \noriented to person, location and place. \n\nCARDIOVASCULAR: The patient remained hemodynamically stable \nintra-op and in the immediate post-operative period. The patient \nwas maintained on IV anti-hypertensive medication in the \nimmediate post-op period, with transition to their oral home \nanti-hypertensives on POD#1. Their vitals signs were closely \nmonitored with telemetry. The patient's home beta-blocker was \ncontinued, as well as their home statin medication. \n\nThe patient did well following their vascular procedure. The \npatient was closely monitored with serial pulse exams in the \npost-op period. If appropriate, doppler signaling was frequently \nassessed in the involved extremity. Their post-op pulse exam \ndemonstrated palpable femoral pulses bilaterally, palpable DP \nbilaterally; and dopplerable ___ bilaterally. The patient's \ncardioprotective dose of Aspirin was continued post-op. The \npatient was loaded with Plavix 300 mg following his procedure \nand will continue 75 mg PO daily in the post-op period, for \n3-months. \n\nRESPIRATORY: The patient was extubated in the immediate post-op \nperiod successfully. The patient had no episodes of desaturation \nor pulmonary concerns. The patient denied cough or respiratory \nsymptoms. Pulse oximetry was monitored closely and the patient \nmaintained adequate oxygenation. \n\nGASTROINTESTINAL: The patient was NPO following their procedure \nand transitioned to sips and a clear liquid diet on POD#0. The \npatient experienced no nausea or vomiting. The patient was \ntransitioned to a regular/cardiac/diabetic healthy diet on POD#1 \nand IV fluids were discontinued once adequate PO intake was \nestablished.\n\nGENITOURINARY: The patient's urine output was closely monitored \nin the immediate post-operative period. A Foley catheter was \nplaced intra-operatively and removed on POD#1, at which time the \npatient was able to successfully void without issue. The \npatient's intake and output was closely monitored for UOP > 30 \nmL per hour output. The patient's creatinine was stable. \n\nHEME: The patient's post-op hematocrit was stable and trended \nclosely. The patient remained hemodynamically stable and did not \nrequire transfusion. The patient's coagulation profile remained \nnormal. The patient had no evidence of bleeding from their \nincision. \n\nID: The patient showed no signs of infection and remained \nafebrile in the post-op period. Their white count was stable \npost-operatively and their incision was closely monitored for \nany evidence of infection or erythema. The patient received only \nstandard ___ antibiotics, and did not require further \nantibiotics post-op.\n\nENDOCRINE: The patient's blood glucose was closely monitored in \nthe post-op period with Q6 hour glucose checks. Blood glucose \nlevels greater than 120 mg/dL were addressed with an insulin \nsliding scale.\n\nPROPHYLAXIS: The patient was maintained on heparin 5000 units SQ \nTID for DVT/PE prophylaxis and encouraged to ambulate \nimmediately post-op once cleared by physical therapy. The \npatient also had sequential compression boot devices in place \nduring immobilization to promote circulation. GI prophylaxis was \nsustained with Protonix/Famotidine when necessary. The patient \nwas encouraged to utilize incentive spirometry, ambulate early \nand was discharged in stable condition."}}
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{'final_diagnoses': ['left lower extremity stasis', 'swelling'], 'procedures': ['___ - left lower extremity diagnostic angiography'], 'visit_summary': "NEURO/PAIN: The patient was maintained on IV pain medication in \nthe immediate post-operative period and transitioned to PO \nnarcotic medication with adequate pain control on ___. The \npatient remained neurologically intact and without change from \nbaseline during their stay. The patient remained alert and \noriented to person, location and place. \n\nCARDIOVASCULAR: The patient remained hemodynamically stable \nintra-op and in the immediate post-operative period. The patient \nwas maintained on IV anti-hypertensive medication in the \nimmediate post-op period, with transition to their oral home \nanti-hypertensives on POD#1. Their vitals signs were closely \nmonitored with telemetry. The patient's home beta-blocker was \ncontinued, as well as their home statin medication. \n\nThe patient did well following their vascular procedure. The \npatient was closely monitored with serial pulse exams in the \npost-op period. If appropriate, doppler signaling was frequently \nassessed in the involved extremity. Their post-op pulse exam \ndemonstrated palpable femoral pulses bilaterally, palpable DP \nbilaterally; and dopplerable ___ bilaterally. The patient's \ncardioprotective dose of Aspirin was continued post-op. The \npatient was loaded with Plavix 300 mg following his procedure \nand will continue 75 mg PO daily in the post-op period, for \n3-months. \n\nRESPIRATORY: The patient was extubated in the immediate post-op \nperiod successfully. The patient had no episodes of desaturation \nor pulmonary concerns. The patient denied cough or respiratory \nsymptoms. Pulse oximetry was monitored closely and the patient \nmaintained adequate oxygenation. \n\nGASTROINTESTINAL: The patient was NPO following their procedure \nand transitioned to sips and a clear liquid diet on POD#0. The \npatient experienced no nausea or vomiting. The patient was \ntransitioned to a regular/cardiac/diabetic healthy diet on POD#1 \nand IV fluids were discontinued once adequate PO intake was \nestablished.\n\nGENITOURINARY: The patient's urine output was closely monitored \nin the immediate post-operative period. A Foley catheter was \nplaced intra-operatively and removed on POD#1, at which time the \npatient was able to successfully void without issue. The \npatient's intake and output was closely monitored for UOP > 30 \nmL per hour output. The patient's creatinine was stable. \n\nHEME: The patient's post-op hematocrit was stable and trended \nclosely. The patient remained hemodynamically stable and did not \nrequire transfusion. The patient's coagulation profile remained \nnormal. The patient had no evidence of bleeding from their \nincision. \n\nID: The patient showed no signs of infection and remained \nafebrile in the post-op period. Their white count was stable \npost-operatively and their incision was closely monitored for \nany evidence of infection or erythema. The patient received only \nstandard ___ antibiotics, and did not require further \nantibiotics post-op.\n\nENDOCRINE: The patient's blood glucose was closely monitored in \nthe post-op period with Q6 hour glucose checks. Blood glucose \nlevels greater than 120 mg/dL were addressed with an insulin \nsliding scale.\n\nPROPHYLAXIS: The patient was maintained on heparin 5000 units SQ \nTID for DVT/PE prophylaxis and encouraged to ambulate \nimmediately post-op once cleared by physical therapy. The \npatient also had sequential compression boot devices in place \nduring immobilization to promote circulation. GI prophylaxis was \nsustained with Protonix/Famotidine when necessary. The patient \nwas encouraged to utilize incentive spirometry, ambulate early \nand was discharged in stable condition.", 'medications_prescribed': ['1. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ6H (every 6 hours) as needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', '2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '3. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \nTwo (2) Puff Inhalation Q6H (every 6 hours) as needed for \nwheezing. ', '4. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff \nInhalation BID (2 times a day). ', '5. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day). ', '6. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '7. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '8. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '9. losartan 100 mg Tablet Sig: One (1) Tablet PO once a day. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Chest Pain', 'medical_history': ['PAST ONCOLOGIC HISTORY:\n- ___: Initial presentation with left-sided rib pain. \n- XR revealed a fracture of the left 9th rib and a 2-cm density \nin the mid right lung. \n- ___: CT Chest showed a 2.6-cm spiculated lesion in the\nright lower lobe, the right upper lobe a 1-cm spiculated lesion, \na T5 vertebral body lytic lesion, and a lytic lesion in the left \n9th rib. \n- ___: Biopsy of the lung lesion in the RLL revealed\nadenocarcinoma, immunohistochemistry staining pattern was \nunusual in that the tumor was CK7 positive, CDX2 positive and \nnegative for TTF-1 and CK20, an immunophenotype not entirely \ntypical for lung adenocarcinoma. There was no ALK \nrearrangement, ROS1 was negative, there was no EGFR mutation and \nKRAS was wild-type \n- ___: Staging workup. MRI brain negative for metastatic \nlesions, MRI T-spine showed known pathologic fracture of T5, \nwithout cord compression, and 3-cm mass in left T9 transverse \nprocess. PET CT showed a 3cm intensely FDG-avid mass in the \nRLL, corresponding to the biopsy-proven adenocarcinoma. \nAdditionally, FGD-avid lesions were found: 2 R hilar LN, \nparaesophageal LN, pretracheal LN, adrenal lesion (not \ncorrelated on CT), T3 vertebral pedicle, T5 lytic lesion, 3cm \nlytic lesion in the left 9th rib, 2 lesions of the left \nposterior acetabulum, large lesion of the left ischial \ntuberosity.\n- ___ Cycle #1 carboplatin AUC 5, pemetrexed 500mg/m2,\nZometa. ___ held for HTN\n- ___ Cycle #2 ___ AUC 5, pemextrexed 500mg/m2, Zometa, \nno ___\n- ___ Cycle #3 ___ AUC 5, pem 500mg/m2, Zometa, no ___ \n- ___ restaging PET/CT: mixed response with progression in \nadrenal\n- ___ Cycle #4 ___ AUC 5, pem 500mg/m2, Zometa\n- ___ Cycle #5 ___ AUC 5, pem 500mg/m2, \n- ___: completed palliative radiation therapy to the\nspine from T2-T6 and to the left ninth rib to a dose of 30 Gy in \n10 fractions\n- ___ Cycle #6 ___ AUC 5, pem 500mg/m2, Zometa, b12\n- ___ restaging PET/CT: continued mixed response\n- ___ Cycle #7 ___ AUC 5, pem 500mg/m2 ___ HS\nreaction \n- ___: Start ___, MPDL3280A\n- ___: ___\n- ___: RTX to left hip and left posterior ischium\n30 Gy given in 10 fractions.\n- ___: Bronchoscopic Bx shows positive metastatic lesions \nin lymph node 4R and 7. Snapshot genetic testing POSITIVE for\nvariants in BRAF, TP53, and STK11.\n- ___: ___ (delayed for XRT)\n- ___: ___. \n- ___: CT Torso showed stable metastatic disease in the\nliver, adrenals, bone (left posterior ribs and T5). Progression \nof pulmonary metastases and mediastinal and hilar nodal \nmetastases. Discontinued clinical trial\n- ___: C1D1 docetaxel monotherapy\n- ___: C2D1 docetaxel monotherapy\n- ___: signed consent for protocol ___\n- ___ (new ERK inhibitor (BVD-523) as part of\nprotocol ___ for ___ mutated NSCLC', 'PAST MEDICAL HISTORY:\n- C1-C2 fracture repaired surgically by Dr. ___ in ___. \n- right total knee replacement\n- overweight\n- hypertension\n- s/p hemorrhoidectomy\n- In ___ on routine colonoscopy he was found to have carcinoid \ntumor in a rectal polyp at ___, observation alone \nrecommended. No colonoscopy since that time.'], 'family_history': 'Mother: died age ___ with lung cancer, throat cancer\nMGM: colon cancer, died ___ years old\nSister: in remission from breast cancer, MI in ___\nFather died age ___ from MI, no known cancer\nBrother age ___, healthy', 'present_illness': 'Mr. ___ is a ___ M with a hx of metatstatic lung cancer on \nchemo, HTN, ongoing tobacco abuse, who initally presented with \nchest pain in ___, and then transferred to \n___ after showing large amount of pericardial effusions and \npulmonary embolism on CTA.\n\nHe started to have substernal pressure-like non-radiating \npleuritic chest pain with some SOB on ___. The pain was better \nwhen leaning forward and non-exertional. Given this, he \npresented to ___. Initial vital signs T \n97.9, HR 81, BP 95/66, Sat 94% ___ L NC. Labs were overall \nunremarkable. Troponin x 2 negative. EKG showed RBBB and low \nvoltage. He had a CTA showing bilateral pulmonary embolism and \nlarge pericardial effusions with small bilateral pleural \neffusion. He was put on heparin gtt. Given that he receives his \noncology care at ___, he was transferred here for further \nmanagement.\n\nUpon transfer to the CCU, initial vitals were: T 98.5, Hr 89, BP \n110/91, RR 16, Sat 89% on 12 L mask. Bedside echo comfirmed \nlarge pericardial effusions, and he was immediately taken to the \ncath lab. Pericardiocentesis was performed with 700 cc \nhemorrhagic fluid removal and drainage placement. Pericardial \npressure dropped from 20 to 0 after tap. After the procedure, he \nreturned to the ICU with no further chest pain, however with \nintermittent L neck pain, which has been chronic.', 'medications': [{'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '425', 'valuenum': 425.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.76', 'valuenum': 3.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '594', 'valuenum': 594.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '64.1', 'valuenum': 64.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '343', 'valuenum': 343.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.6', 'valuenum': 39.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ON ADMISSION:\n==============\nVITALS: T: 98.5, Hr 103, BP 123/61, RR 16, Sat 88% on 10 L mask\nGen: A&OX3\nNECK: JVD 10 cm\nChest: port and pericardial drainage in place, no erythema or \nchest wall tenderness\nCV: RRR, s1s2 WNL, mild rub, no gallop, murmur\nLUNGS: CTAB anteriorly\nABD: soft, +BS. LUQ and RUQ tenderness, no guarding or rebound \ntenderness\nEXT: wwwp, 2+ pulses, no peripheral edema\nNEURO: no focal deficits \n\nON DISCHARGE:\n============\nVS: 98.1 112/70 77 18 98%3L \npleurex drainage ___ \nGENERAL: middle-aged male, sitting up in chair, in NAD\nHEENT: L pupil > R pupil, NC, AT\nCARDIAC: regular, no murmurs\nLUNG: rales at R and L base, breathing comfortably on nasal \ncannula CHEST: TTP over R posterior lateral chest and right \nposterior back \nABD: soft, diffusely tender to palpation RUQ TTP near site of \npleurX\nEXT: LLE edema over shins L>R \nNEURO: moving extremities semetrically', 'diagnoses': [{'icd_code': '44422', 'desc': 'Arterial embolism and thrombosis of lower extremity'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '78052', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}], 'summary': 'ADMISSION LABS:\n==============\n___ 10:06PM BLOOD WBC-8.2 RBC-3.67* Hgb-9.8* Hct-29.6* \nMCV-81* MCH-26.6* MCHC-33.1 RDW-17.5* Plt ___\n___ 10:06PM BLOOD Neuts-76.4* Lymphs-14.0* Monos-8.1 \nEos-1.1 Baso-0.4\n___ 10:06PM BLOOD Plt ___\n___ 12:08AM BLOOD ___ PTT-60.8* ___\n___ 10:06PM BLOOD Glucose-99 UreaN-20 Creat-0.8 Na-131* \nK-4.3 Cl-99 HCO3-24 AnGap-12\n___ 10:06PM BLOOD cTropnT-<0.01 proBNP-504*\n___ 10:06PM BLOOD Albumin-2.5* Calcium-7.7* Phos-3.1 Mg-2.2\n___ 04:54AM BLOOD HIV Ab-NEGATIVE\n___ 05:30PM PERICARDIAL FLUID WBC-1311* Hct,Fl-5.5* \nPolys-42* Lymphs-29* Monos-3* Macro-25* Other-1*\n___ 05:30PM PERICARDIAL FLUID TotProt-4.4 Glucose-65 \nLD(LDH)-1262 Amylase-19 Albumin-2.4\n\nIMAGING:\n==========\nTRANSTHORACIC ECHOCARDIOGRAM ___:\nConclusions \nThe IVC is dilated with less than 50% inspiratory reduction in \ndiameter. There is a moderate to large sized circumferential \npericardial effusion. There is sustained right atrial collapse, \nconsistent with low filling pressures or early tamponade. There \nis invagination of the RV free wall in early diastole. There is \nsignificant, accentuated respiratory variation in mitral valve \ninflows, consistent with impaired ventricular filling. \nIMPRESSION: Moderate-large circumferential pericardial effusion \nwith evidence of early tamponade. \n\nTRANSTHORACIC ECHOCARDIOGRAM ___:\nThere is a large (>2.0cm) pericardial effusion primarily \nanterior to the right atrial free wall. There is minimal fluid \nbeyond the mid-right ventricular free wall and extending around \nthe apex and inferloateral left ventricular free wall. There is \nintermittent minimal right ventricular diastolic collapse c/w \nincreased pericardial pressure. \n\nCompared with the prior study (images reviewed) of ___, \nthe loculated anterior effusion is new. \n\nCHEST (PORTABLE AP) ___:\nIMPRESSION: \nRight-sided port terminates in the right atrium. \nRight pleural effusion, low right lung volume with indistinct \nvisualization of known right pulmonary masses. \nCardiomegaly, with likely pulmonary edema. \n\nCT Chest ___\nIMPRESSION: \nMediastinal and right hilar lymphadenopathy, minimally different \nas compared to ___. New moderate right and small left \npleural effusion \n \nNew since ___ but present on ___ pericardial \neffusion, with \npericardial enhancement and pericardial loculations, status post \nplacement of the pericardial drainage. \n \nDominant right lower lobe mass, overall was no substantial \nchange. \n \nMetastatic involvement of the posterior aspect of the left ninth \nrib, \nunchanged. \n \nTip of the central venous catheter is at the inflow area of the \nIVC into right atrium. \n \nAssessment of the upper abdomen included in adrenals and liver \nwill be done separately as part of the CT abdomen and \ncorresponding report will be issued. \n\nCT Abdomen/Pelvis\nIMPRESSION: \n \nWorsening disease with interval increase in size of hepatic \nsegment II \nmass as well as retroperitoneal and perigastric lymphadenopathy \nsince ___. Stable bilateral adrenal metastases and \nleft ischial tuberosity osseous metastasis. No new disease in \nthe abdomen or pelvis. \n\nMRI brain: \nIMPRESSION: \n1. Motion limited exam. \n2. Small, mostly ring-enhancing lesions in the right frontal, \nleft parietal, \nand right temporal lobes, and in the left cerebellar hemisphere, \ncompatible \nwith metastatic disease. No significant mass effect. \n\nMICROBIOLOGY:\n==============\n___ 5:30 pm FLUID,OTHER PERICARDIAL FLUID. \n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n FLUID CULTURE (Preliminary): NO GROWTH. \n ANAEROBIC CULTURE (Preliminary): \n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n ACID FAST CULTURE (Preliminary): \n FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. \n\n___ 5:30 pm BLOOD CULTURE PERICARDIAL FLUID. \n Blood Culture, Routine (Pending): \n\n___ 10:06 pm MRSA SCREEN Source: Nasal swab. \n MRSA SCREEN (Pending): \n\n___ CYTOLOGY PERICARDIAL FLUID\nNegative for malignant cells\n\nDISCHARGE LABS:\n================\n\n___ 06:10AM BLOOD WBC-7.0 RBC-3.05* Hgb-7.8* Hct-24.9* \nMCV-82 MCH-25.6* MCHC-31.4 RDW-18.6* Plt ___\n___ 06:10AM BLOOD Glucose-91 UreaN-15 Creat-0.6 Na-131* \nK-4.8 Cl-96 HCO3-26 AnGap-14\n___ 06:10AM BLOOD Calcium-8.3* Phos-2.6* Mg-2.___\nRIEF SUMMARY\n==============\n___ with a hx of metatstatic NSCLC on chemo, HTN, ongoing \ntobacco abuse p/w acute onset CP found to have bilateral PEs and \nlarge pericardial effusion s/p pericardiocentesis. Also found to \nhave brain metastasis with possible seizure activity. Patient \nwas started on whole brain radiation, dexamethasone and keppra. \n \nACTIVE ISSUES\n==============\n# Pericardial effusion: CTA at OSH and bedside echo showed large \npericardial effusion, which was not shown in his chest CT scan \non ___. Bedside TTE showed mild RV diastolic collapse. He \nunderwent pericardiocentesis with 700 cc hemorrhagic fluid \nremoval and with drain kept in place. Given his cancer history, \netiology initially believed to be malignant. Viral or idiopathic \nwere also possible although less likely. Serial pulsus were \nwithin normal limits. Pericardial fluid analysis and cytology \nwere not remarkable. Repeat TTE was notable for larger effusion \n2.5 cm anterior to RA and basal half of RV. Subsequently, the \ndecision was made to consult thoracic surgery. He was taken to \nthe OR for pericardial window on ___ with the placement of a \nright-sided Pleur-X catheter for continued drainage of his \npericardial effusion. Pathology from the pericardium resection \ncame back with malignant adenocarcinoma cells confirming \nmalignant effusion. Patient tolerated the procedure well and was \nmonitored in the ICU for 24 hours post procedure then \ntransferred to the hematology/oncology ward. On arrival to the \nward, patient was doing well, pain controlled, and satting \n96-98% on 4L NC. His pain medications were titrated \nappropriately and he was discharged on oxycontin and oxycodone. \nHis pleurX catheter was capped and was drained daily by nursing \nstaff. \n\n# Bilateral pulmonary embolism: On admission, the patient was \nfound to have bilateraly pulmonary embolism on OSH CTA. The \npatient did not have significant hemodynamic compromise from his \nPE. Troponin x 2 were negative at OSH with no evidence of RV \ndilatation ___ sign on TTE. The patient was managed on \nheparin gtt and subsequently transitioned to Lovenox 1 mg/kg BID \nfor long term anticoagulation. He received lovenox teaching and \na prescription for lovenox injections prior to discharge.\n\n# Pleural effusion: While the patient was in-house, he had a CT \ntorso (previously planned as an outpatient). This showed a new \nmoderate right and small left pleural effusion on CT chest ___. \nA pleurX catheter was placed on ___. The catheter was capped \nprior to discharge. Wife was taught to drain pleurex catheter \nwhich should be drained daily. Average pleurex output at \ndischarge was 450cc/day. \n\n# Brain metastases: upon arrival to the floor, patient had \nepisdoes of LUE "twitching" followed by an episode of \ninvoluntary "head shaking" on ___. Given malignancy and \npresentation of these neurological symptoms, there was a low \nsuspicion for CNS involvement due to metastatic disease. MRI \nhead w/ & w/o contrast was done on ___ which showed at least \nfour lesions concerning for metastatic disease. Neuro oncology \nwas consulted and recommended a Keppra load and BID dosing. Rad \nonc was consulted and recommended ___ sessions of whole brain \nradiation which was initiated in house. Patient had \nunresponsive episide after first XRT session, thought to \npossibly represent seizure. EEG did not reveal active seizure \nactivity. Per neuro- onc instructions he was started on \ndexamethasone 4mg daily and keppra was incraesed to 1500 mg BID. \n\n\n# Hypertension: The patient was normotensive during his CCU. \nGiven initial concern for early tamponande, the patient\'s home \nanti-hypertensives were held. On discharge, patients bp was \nstable in the 100s on no antiHTN. \n\n# Hyponatremia: Believed to be ___ SIADH given pulmonary \nlesionsfrom NSCLC and likely contribution from his pain. It was \nstable at 131 at discharge. \n\nCHRONIC ISSUES\n==============\n# Metastatic NSCLC: Currently on study here at ___. He had CT \ntorso while in-house, which showed interval progression of \nhepatic mass and retroperitoneal and perigastric \nlymphadenopathy. His oncology providers were notified. \nUltimately after his pericardial window, he was transferred to \nthe OMED service. Acute pain was consulted to help with pain \ncontrol, they recommended medical management as outlined above. \nPatient was discharged on oxycontin and oxycodone PRN for pain \nfor pain.\n\n# Chronic pain: The patient\'s home narcotics were resumed. He \nwas given IV Dilaudid prn doses during his hospitalization for \nabdominal pain from his known mets. The IV pain medications were \ndiscontinued prior to time of discharge.\n\n# Transitions in care:\n-- Patient will return for radiation oncology apppointments as \nindicated on discharge worksheet. \n-- Follow up with Dr. ___ in ___ clinic\n-- Follow up with Dr. ___ in thoracic surgery clinic\n-- Continue taking oxycontin 120mg TID with ___ oxycodone \n___ Q4:PRN for breakthrough pain\n-- Continue gabapentin 600mg TID for nerve pain\n-- Continue lovenox injections twice daily for treatment of the \nbilateral pulmonary emboli\n-- Nursing care for pleurX catheter management and drainage. \n-- Pleurex catheter should be drained daily. \n--Patient will return to ___ for Radiation/ Oncology sessions \nof whole brain radiation therapy likely in ___ fractions to be \nstarted ___\n-- Patient started home O2 therapy at discharge\n-- Full code\n-- Emergency contact: HCP: ___ ___\n-- anti HTN meds stopped on discharge as patient not HTN please \nreevaluate as an outpatient \n-- QTc measured on ___\n-- Patient experienced significant anxiety during this \nhospitalization surrounding pleurex catheter and pain. He \ndeclined to see psychiatry as an outpatient. Please continue to \nreevaluate.'}}
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{'final_diagnoses': ['pericardial effusion secondary to metastatic \nnon small cell lung cancer', 'metastatic non small cell lung cancer', 'pulmonary embolism'], 'procedures': ['Pericardiocentesis ___', 'Pericardial window ___', 'pleurX catheter placement ___'], 'visit_summary': 'RIEF SUMMARY\n==============\n___ with a hx of metatstatic NSCLC on chemo, HTN, ongoing \ntobacco abuse p/w acute onset CP found to have bilateral PEs and \nlarge pericardial effusion s/p pericardiocentesis. Also found to \nhave brain metastasis with possible seizure activity. Patient \nwas started on whole brain radiation, dexamethasone and keppra. \n \nACTIVE ISSUES\n==============\n# Pericardial effusion: CTA at OSH and bedside echo showed large \npericardial effusion, which was not shown in his chest CT scan \non ___. Bedside TTE showed mild RV diastolic collapse. He \nunderwent pericardiocentesis with 700 cc hemorrhagic fluid \nremoval and with drain kept in place. Given his cancer history, \netiology initially believed to be malignant. Viral or idiopathic \nwere also possible although less likely. Serial pulsus were \nwithin normal limits. Pericardial fluid analysis and cytology \nwere not remarkable. Repeat TTE was notable for larger effusion \n2.5 cm anterior to RA and basal half of RV. Subsequently, the \ndecision was made to consult thoracic surgery. He was taken to \nthe OR for pericardial window on ___ with the placement of a \nright-sided Pleur-X catheter for continued drainage of his \npericardial effusion. Pathology from the pericardium resection \ncame back with malignant adenocarcinoma cells confirming \nmalignant effusion. Patient tolerated the procedure well and was \nmonitored in the ICU for 24 hours post procedure then \ntransferred to the hematology/oncology ward. On arrival to the \nward, patient was doing well, pain controlled, and satting \n96-98% on 4L NC. His pain medications were titrated \nappropriately and he was discharged on oxycontin and oxycodone. \nHis pleurX catheter was capped and was drained daily by nursing \nstaff. \n\n# Bilateral pulmonary embolism: On admission, the patient was \nfound to have bilateraly pulmonary embolism on OSH CTA. The \npatient did not have significant hemodynamic compromise from his \nPE. Troponin x 2 were negative at OSH with no evidence of RV \ndilatation ___ sign on TTE. The patient was managed on \nheparin gtt and subsequently transitioned to Lovenox 1 mg/kg BID \nfor long term anticoagulation. He received lovenox teaching and \na prescription for lovenox injections prior to discharge.\n\n# Pleural effusion: While the patient was in-house, he had a CT \ntorso (previously planned as an outpatient). This showed a new \nmoderate right and small left pleural effusion on CT chest ___. \nA pleurX catheter was placed on ___. The catheter was capped \nprior to discharge. Wife was taught to drain pleurex catheter \nwhich should be drained daily. Average pleurex output at \ndischarge was 450cc/day. \n\n# Brain metastases: upon arrival to the floor, patient had \nepisdoes of LUE "twitching" followed by an episode of \ninvoluntary "head shaking" on ___. Given malignancy and \npresentation of these neurological symptoms, there was a low \nsuspicion for CNS involvement due to metastatic disease. MRI \nhead w/ & w/o contrast was done on ___ which showed at least \nfour lesions concerning for metastatic disease. Neuro oncology \nwas consulted and recommended a Keppra load and BID dosing. Rad \nonc was consulted and recommended ___ sessions of whole brain \nradiation which was initiated in house. Patient had \nunresponsive episide after first XRT session, thought to \npossibly represent seizure. EEG did not reveal active seizure \nactivity. Per neuro- onc instructions he was started on \ndexamethasone 4mg daily and keppra was incraesed to 1500 mg BID. \n\n\n# Hypertension: The patient was normotensive during his CCU. \nGiven initial concern for early tamponande, the patient\'s home \nanti-hypertensives were held. On discharge, patients bp was \nstable in the 100s on no antiHTN. \n\n# Hyponatremia: Believed to be ___ SIADH given pulmonary \nlesionsfrom NSCLC and likely contribution from his pain. It was \nstable at 131 at discharge. \n\nCHRONIC ISSUES\n==============\n# Metastatic NSCLC: Currently on study here at ___. He had CT \ntorso while in-house, which showed interval progression of \nhepatic mass and retroperitoneal and perigastric \nlymphadenopathy. His oncology providers were notified. \nUltimately after his pericardial window, he was transferred to \nthe OMED service. Acute pain was consulted to help with pain \ncontrol, they recommended medical management as outlined above. \nPatient was discharged on oxycontin and oxycodone PRN for pain \nfor pain.\n\n# Chronic pain: The patient\'s home narcotics were resumed. He \nwas given IV Dilaudid prn doses during his hospitalization for \nabdominal pain from his known mets. The IV pain medications were \ndiscontinued prior to time of discharge.\n\n# Transitions in care:\n-- Patient will return for radiation oncology apppointments as \nindicated on discharge worksheet. \n-- Follow up with Dr. ___ in ___ clinic\n-- Follow up with Dr. ___ in thoracic surgery clinic\n-- Continue taking oxycontin 120mg TID with ___ oxycodone \n___ Q4:PRN for breakthrough pain\n-- Continue gabapentin 600mg TID for nerve pain\n-- Continue lovenox injections twice daily for treatment of the \nbilateral pulmonary emboli\n-- Nursing care for pleurX catheter management and drainage. \n-- Pleurex catheter should be drained daily. \n--Patient will return to ___ for Radiation/ Oncology sessions \nof whole brain radiation therapy likely in ___ fractions to be \nstarted ___\n-- Patient started home O2 therapy at discharge\n-- Full code\n-- Emergency contact: HCP: ___ ___\n-- anti HTN meds stopped on discharge as patient not HTN please \nreevaluate as an outpatient \n-- QTc measured on ___\n-- Patient experienced significant anxiety during this \nhospitalization surrounding pleurex catheter and pain. He \ndeclined to see psychiatry as an outpatient. Please continue to \nreevaluate.', 'medications_prescribed': ['Docusate Sodium 100 mg PO BID', 'Gabapentin 600 mg PO TID \nRX *gabapentin 300 mg 2 capsule(s) by mouth three times a day \nDisp #*84 Capsule Refills:*0', 'Lactulose 30 mL PO Q8H:PRN constipation', 'Lorazepam 1 mg PO Q6H:PRN anxiety \nRX *lorazepam [Ativan] 1 mg 1 tablet by mouth Q6H:PRN Disp #*30 \nTablet Refills:*0', 'Magnesium Citrate 300 mL PO DAILY:PRN constipation', 'Ondansetron 8 mg PO Q8H:PRN nausea', 'OxyCODONE SR (OxyconTIN) 120 mg PO Q8H', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Prochlorperazine 10 mg PO Q6H:PRN nausea', 'Ranitidine 150 mg PO BID', 'Enoxaparin Sodium 100 mg SC Q12H \nRX *enoxaparin 100 mg/mL ___very 12 hours Disp #*60 \nSyringe Refills:*0', 'Nicotine Patch 21 mg TD DAILY \nRX *nicotine 21 mg/24 hour 1 patch daily Disp #*28 Patch \nRefills:*0', 'Senna 8.6 mg PO BID Constipation \nRX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp \n#*56 Capsule Refills:*2', 'Lidocaine-Prilocaine 1 Appl TP PRN prior to port access', 'Zometa (zoledronic acid;<br>zoledronic acid-mannitol-water) \n4 mg/5 mL injection monthly', 'Home Oxygen\nDiagnosis: lung adenocarcinoma ___Resting room air oxygen saturation: 87-88%', 'Dexamethasone 4 mg PO QAM \nRX *dexamethasone 4 mg 1 tablet(s) by mouth QAM Disp #*28 Tablet \nRefills:*0', 'LeVETiracetam 1500 mg PO BID \nRX *levetiracetam 750 mg 2 tablet(s) by mouth twice a day Disp \n#*56 Tablet Refills:*1', 'OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN \nBreakthrough pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth q4 Disp #*160 Tablet \nRefills:*0', 'shower chair\nDispense 1 shower chair\nICD9: 162.9', 'commode\ndispense 1 commode\nICD9: 162.9', 'Outpatient Physical Therapy\nRolling Walker\nICD9 162.9\nLength of use 18 months\nPrognosis: Fair', 'rolling walker\nrolling walker\nICD 9 162.5 \nLength of need > 13 months \nprognosis: good']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'F', 'symptoms': 'CC: fever, chills, chest pain', 'medical_history': ['1. Adrenal crisis. On several occasions, she reports a history \nof adrenal insufficiency, which was diagnosed in ___.', '2. Aspiration pneumonia as above.', '3. Appendicitis ___ did not undergo appendectomy.', '4. Moderate-to-severe asthma; has been hospitalized several \ntimes for this.', '5. Hypertension; has had since she was ___ years old.', '6. Degenerative disc disease.', '7. Arthritis.', '8. GERD, very severe.', '9. Oral thrush in past.', '10. PTSD.', '11. Chronic pain.', '12. Insulin resistance.', '13. Has had history of ___ virus in the past.', '14. s/p Total abdominal hysterectomy in ___, \ncholecystectomy in ___, C-section, discectomy and laminectomy.', '15. PCOS', '16. Seizure disorder'], 'family_history': 'Grandfather with colon cancer; father with lung cancer, \nesophageal cancer, melanoma.', 'present_illness': 'Ms. ___ is a ___ F with a medical history notable for asthma, \nadrenal insufficiency, HTN, GERD and chronic back pain.\n\nShe has had multiple hospital visits for the SOB/cough this ___. She reports this all started after a bad pneumonia ___. Since then, she has noted periods of dyspnea, chest \npain, and cough.\n\n2 days prior to admissoin she noted fever (T 101), chills, \nproductive cough with "rusty-colored sputum", and pleuritic \nchest pain. Her chest pain is mostly right-sided rib pain and \nnot exertional. She also had an episode of shaking, palor, and \nchest pain at a Subway restaurant last evening though she does \nnot remember all of the details.\n\nVitals on arrival to ___ ED: T 98, P ___, BP 165/116, 99% on \nRA. Her CXR revealed no infiltrate. In the ED she received \nnebulizer treatments and prednisone 20mg. Her peak flows were \n220, 270, and 300.\n\nROS: She reports: diffuse arthralgias, leg swelling, back pain, \nheadaches.', 'medications': [{'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Montelukast Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Oint 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Cream 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sumatriptan Succinate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Desonide 0.05% Cream', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sumatriptan Succinate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Clobetasol Propionate 0.05% Ointment', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clobetasol Propionate 0.05% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clonazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone Cream 2.5%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sumatriptan Succinate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clobetasol Propionate 0.05% Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydroxychloroquine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Talc', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Viscous 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Naproxen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocerin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sumatriptan Succinate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Cream 2.5%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fondaparinux Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sumatriptan Succinate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58.8', 'valuenum': 58.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.006', 'valuenum': 1.006, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Straw', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97.2', 'valuenum': 97.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82.1', 'valuenum': 82.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88.2', 'valuenum': 88.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54.1', 'valuenum': 54.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69.3', 'valuenum': 69.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.0', 'valuenum': 49.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66.9', 'valuenum': 66.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74.2', 'valuenum': 74.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90.8', 'valuenum': 90.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYZED, MODERATELY.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76.9', 'valuenum': 76.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67.3', 'valuenum': 67.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96.5', 'valuenum': 96.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '69.2', 'valuenum': 69.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.5', 'valuenum': 87.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.29', 'valuenum': 4.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.4', 'valuenum': 19.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '244', 'valuenum': 244.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '336', 'valuenum': 336.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 90.0, 'ref_range_upper': 180.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'POSITIVE *.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1:160 PATTERN-SPECKLED. ROUGHLY 20% OF HEALTHY INDIVIDUALS HAVE ANA TITERS OF 1:40 OR 1:80. HIGHER TITERS(1:160 AND ABOVE) ARE SEEN IN ONLY 5% OF NORMALS.'}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.8, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '926', 'valuenum': 926.0, 'valueuom': 'mg/dL', 'ref_range_lower': 700.0, 'ref_range_upper': 1600.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 40.0, 'ref_range_upper': 230.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'GPL', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '0-15 GPL: NEGATIVE;15-20 GPL: INDETERMINATE; >20 GPL: POSITIVE.'}, {'value': '___', 'valuenum': 14.5, 'valueuom': 'MPL', 'ref_range_lower': 0.0, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '0-12.5 MPL: NEGATIVE;12.5-20 MPL: INDETERMINATE; >20 MPL: POSITIVE.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90.0', 'valuenum': 90.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '215', 'valuenum': 215.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': '%', 'ref_range_lower': 69.0, 'ref_range_upper': 121.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': '%', 'ref_range_lower': 67.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '211', 'valuenum': 211.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66.6', 'valuenum': 66.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '266', 'valuenum': 266.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.76', 'valuenum': 3.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vital Signs: T 98.8, P 84, BP 117/77, 96% on RA.\n\nPhysical examination:\n- Gen: Obese female sitting upright in bed. She is tearful \nduring the exam and quite frustrated with her many medical \nproblems.\n- HEENT: Oropharynx clear w/out lesions.\n- Neck: Supple with no thyromegaly or lymphadenopathy.\n- Chest: Normal respirations and breathing comfortably on room \nair. Lungs clear to auscultation bilaterally.\n- CV: Regular rhythm. Normal S1, S2. No murmurs or gallops. JVP \nunable to be visualized.\n- Abdomen: Normal bowel sounds. Soft, nontender, nondistended. \n- MSK: Joints with no redness, swelling, warmth. However, she is \ntender at the knees, ankles, feet, calves, hands.\n- Skin: No lesions, bruises, rashes.\n- Neuro: Alert, oriented x3. Good fund of knowledge. Able to \ndiscuss current events and memory is intact. CN ___ intact. \nSpeech and language are normal. \n- Psych: She has poor hygeine. She does not answer questions \ndirectly when asked but typically provides other, ___ \nmedical history. She knows a remarkable amount of medical \nterminology.', 'diagnoses': [{'icd_code': '4441', 'desc': 'Embolism and thrombosis of thoracic aorta'}, {'icd_code': '59381', 'desc': 'Vascular disorders of kidney'}, {'icd_code': '7100', 'desc': 'Systemic lupus erythematosus'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}, {'icd_code': '6930', 'desc': 'Dermatitis due to drugs and medicines taken internally'}, {'icd_code': 'E9478', 'desc': 'Other drugs and medicinal substances causing adverse effects in therapeutic use'}, {'icd_code': '3004', 'desc': 'Dysthymic disorder'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '24290', 'desc': 'Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': 'Admission Labs:\n - ___ 08:50PM GLUCOSE-148* UREA N-14 CREAT-1.0 \nSODIUM-135 POTASSIUM-3.8 CHLORIDE-99 TOTAL CO2-25 ANION GAP-15 \ncTropnT-<0.01 LACTATE-1.8 CALCIUM-9.9 PHOSPHATE-3.2 \nMAGNESIUM-2.1\n - ___ 08:50PM WBC-7.6 (NEUTS-77.1* ___ MONOS-3.7 \nEOS-0.7 BASOS-0.5) RBC-4.45 HGB-11.6* HCT-34.6* MCV-78* \nMCH-26.1* MCHC-33.5 RDW-16.4* PLT COUNT-300\n - ___ 08:50PM ___ PTT-21.5* ___\n - ___ 09:20PM URINE COLOR-Straw APPEAR-Clear SP \n___ BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG \nKETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG\n\nChest X-Ray: Lung volumes remain relatively low, but slightly \nmore expanded than on the prior study. No consolidation or edema \nis evident. The mediastinum is unremarkable. The cardiac \nsilhouette remains top normal for size accounting for patient \nand technical factors. No effusion or pneumothorax is noted. \nMild degenerative disease is seen throughout the thoracic spine. \nThe patient has undergone prior cholecystectomy. IMPRESSION: No \ndefinite focal consolidation. Study is mildly limited due to\nbody habitus. \n\nCXR: SR at 110. Normal axis and intervals. Good RWP. No \npathologic Q waves. No ST or T wave abnormalities.\nMs. ___ breathing has improved by arrival to the floor. \nHer CXR, ECG, and laboratory studies are all within normal \nlimits. \n\n1. Shortness of breath: likely due to asthma, as her peak flow \nis down from her reported max of 425 and symptoms improved in ED \nwith nebs and steroids. Acute pulmonary edema could also \ncontribute; she is scheduled for an outpatient TTE tomorrow to \nevaluate her cardiac function. She continues to have mild ___ \nedema; lasix was continued at home dose. Panic attack is also \non the differential. She was continued on home regimen of \nAdvair and nebulizers without further incident. She will follow \nup with her PNP tomorrow for further evaluation and management. \n\n2. Hypertension: continued home Ace-In and amlodipine\n\n3. Chronic Pain: Continued home medications of tizanidine, \nFlexeril, and oral Dilaudid. She was given a 3 day prescription \nfor these medications at discharge due to the impending \nhurricane and her concern that she will not be able to make it \nto her PCP visit tomorrow. PCP notified of this. \n\n4. Hypothyroid: continue Levothyroxine.'}}
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{'final_diagnoses': ['Asthma', 'Chronic pain syndrome', 'HTN', 'PTSD'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ breathing has improved by arrival to the floor. \nHer CXR, ECG, and laboratory studies are all within normal \nlimits. \n\n1. Shortness of breath: likely due to asthma, as her peak flow \nis down from her reported max of 425 and symptoms improved in ED \nwith nebs and steroids. Acute pulmonary edema could also \ncontribute; she is scheduled for an outpatient TTE tomorrow to \nevaluate her cardiac function. She continues to have mild ___ \nedema; lasix was continued at home dose. Panic attack is also \non the differential. She was continued on home regimen of \nAdvair and nebulizers without further incident. She will follow \nup with her PNP tomorrow for further evaluation and management. \n\n2. Hypertension: continued home Ace-In and amlodipine\n\n3. Chronic Pain: Continued home medications of tizanidine, \nFlexeril, and oral Dilaudid. She was given a 3 day prescription \nfor these medications at discharge due to the impending \nhurricane and her concern that she will not be able to make it \nto her PCP visit tomorrow. PCP notified of this. \n\n4. Hypothyroid: continue Levothyroxine.', 'medications_prescribed': ['1. Tizanidine 2 mg Tablet Sig: Four (4) Tablet PO QHS (once a \nday (at bedtime)).\nDisp:*12 Tablet(s)* Refills:*0*', '2. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO once a day. ', '3. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day). ', '4. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Benazepril 10 mg Tablet Sig: Two (2) Tablet PO BID (2 times a \nday). ', '6. Femtrace 0.9 mg Tablet Sig: One (1) Tablet PO daily (). ', '7. Diazepam 5 mg Tablet Sig: One (1) Tablet PO TID (3 times a \nday) as needed for anxiety.\nDisp:*9 Tablet(s)* Refills:*0*', '8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '9. ProAir HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: ___ puff \nInhalation once a day. ', '10. Hydrocortisone 20 mg Tablet Sig: One (1) Tablet PO QAM (once \na day (in the morning)). ', '11. Hydrocortisone 5 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '12. Cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3 \ntimes a day) as needed for back spasm.\nDisp:*9 Tablet(s)* Refills:*0*', '13. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '14. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). ', '15. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, \nRapid Dissolve PO every eight (8) hours as needed for nausea. ', '16. Hyoscyamine Sulfate 0.125 mg Tablet Sig: One (1) Tablet PO \nonce a day as needed for nausea. ', '17. Dilaudid 8 mg Tablet Sig: One (1) Tablet PO every six (6) \nhours as needed for pain.\nDisp:*12 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': 'pancreatic lesion and CBD dilatation', 'medical_history': ['- CAD', '- HTN', '- HLD', '- GERD', '- BPH'], 'family_history': 'unable to obtain', 'present_illness': ' ___ year old ___ man with CAD, HTN, HLD, BPH, and \nGERD, transferred from ___ for pancreatic lesion & CBD \ndilatation. Pt has had epigastric pain, nausea, vomiting x 4d. \nAt ___ U/S showed CBD dilation to 1.7cm and 1.3cm \ncomplex cystic lesion in head of pancreas. Labs significant for \nTbili 2.0, ALT/AST 253/136. Patient was transferred to ___ for \nMRCP. \n.\nIn the ___ ED initial VS were 97.0, 58, 130/83, 16, 97% RA. No \nlabs or imaging performed. \n.\nCurrently, patient is comfortable and denies any nausea or \nabdominal pain. \n.\nROS: As noted in HPI, otherwise unremarkable. ', 'medications': [{'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'LOPERamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.8', 'valuenum': 87.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.78', 'valuenum': 4.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES ALT.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY DECREASES ALP..'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES AST..'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 291.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES CK.. NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.7,. Estimated GFR = 29 if non African-American (mL/min/1.73 m2). Estimated GFR = 35 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'value': '___', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES P..'}, {'value': '___', 'valuenum': 8.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 22.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS. HEMOLYZED SPECIMEN.'}, {'value': '___', 'valuenum': 3.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '___', 'valuenum': 6.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. HEMOLYZED SPECIMEN.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POS.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.027', 'valuenum': 1.027, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '150', 'valuenum': 150.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.53', 'valuenum': 4.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '221', 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'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.77', 'valuenum': 4.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS: 95.8, 141/63, 65, 16, 96% RA \nGeneral: Well appearing man in NAD \nHEENT: Mild icterus \nNeck: Supple, JVP flat, no LAD \nCV: Regular, no m/r/g \nLungs: CTAB\nAbdomen: Distended but soft and non-tender, no fluid wave \nGU: No foley \nExt: WWP, no edema \nNeuro: CN II-XII intact, strength and sensation grossly intact\nSkin: Slightly jaundiced\nPulses: 2+ pedal pulses\n\nDISCHARGE PHYSICAL EXAM:\nVS: 98.1, 59-64, 120-146/55-65, 18, 98%RA \nGeneral: Well appearing man in NAD \nHEENT: Mild scleral icterus \nNeck: Supple, JVP flat, no LAD \nCV: Regular, no m/r/g \nLungs: CTAB \nAbdomen: soft, nontender to palpation \nGU: No foley \nExt: WWP, no edema \nNeuro: CN II-XII intact, strength and sensation grossly intact \nSkin: Slightly jaundiced \nPulses: 2+ pedal pulses ', 'diagnoses': [{'icd_code': '03842', 'desc': 'Septicemia due to escherichia coli [E. coli]'}, {'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '514', 'desc': 'Pulmonary congestion and hypostasis'}, {'icd_code': '2763', 'desc': 'Alkalosis'}, {'icd_code': '41189', 'desc': 'Other acute and subacute forms of ischemic heart disease, other'}, {'icd_code': '59080', 'desc': 'Pyelonephritis, unspecified'}, {'icd_code': 'V4987', 'desc': 'Physical restraints status'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '29680', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': 'E9309', 'desc': 'Unspecified antibiotic causing adverse effects in therapeutic use'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4380', 'desc': 'Late effects of cerebrovascular disease, cognitive deficits'}, {'icd_code': 'V1588', 'desc': 'History of fall'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '4011', 'desc': 'Benign essential hypertension'}, {'icd_code': '25201', 'desc': 'Primary hyperparathyroidism'}, {'icd_code': '5920', 'desc': 'Calculus of kidney'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '73390', 'desc': 'Disorder of bone and cartilage, unspecified'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}], 'summary': "ADMISSION LABS:\n===============\n___ 10:44PM cTropnT-<0.01\n___ 10:40PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 10:40PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 \nLEUK-NEG\n\nDISCHARGE LABS:\n==============\n___ 07:25AM BLOOD WBC-7.8 RBC-3.75* Hgb-11.9* Hct-35.3* \nMCV-94 MCH-31.9 MCHC-33.8 RDW-12.1 Plt ___\n___ 07:25AM BLOOD Glucose-82 UreaN-20 Creat-1.0 Na-143 \nK-4.1 Cl-105 HCO3-25 AnGap-17\n___ 07:25AM BLOOD ALT-198* AST-103* LD(LDH)-195 \nAlkPhos-259* TotBili-1.2\n___ 07:25AM BLOOD Calcium-9.2 Phos-2.5* Mg-1.6\n\nIMAGING:\n========\nIMPRESSION:\n \n1. There is no solid or obstructing mass identified within the \npancreatic\nhead. Within the pancreatic neck there is a 1 cm cyst most \ncompatible with a side branch IPMN as described above which \ncorresponds to the abnormality seen on the ultrasound. Smaller \ncysts are seen in the pancreatic head. \n \n2. There is dilatation of the common bile duct measuring up to \n1 cm without evidence of obstruction. Pneumobilia is seen, \nstatus post ERCP and\nsphincterotomy. \n \n3. Benign appearing lesions within the liver including a \nsegment 6\nhemangioma, and FNH/perfusional abnormalities as described \nabove. \n \n4. Trace pleural effusions. \n\nPATHOLOGY:\n=========\nSPECIMEN SUBMITTED: Cell block CBD brushings ___\nProcedure date Tissue received Report Date Diagnosed \nby \n___ ___. ___ \nPrevious biopsies: ___ G I BIOPSY (1 JAR). \nDIAGNOSIS: \nCommon bile duct brushings, cell block:\n\n Atypical.\n\n Atypical glandular epithelial cells cannot further classify.\n\nSPECIMEN SUBMITTED: G I BIOPSY (1 JAR).\n\nProcedure date Tissue received Report Date Diagnosed \nby \n___ ___. ___ \n\nDIAGNOSIS: \n\nAmpullary mucosal biopsies: \n\nSmall intestinal mucosa with focal surface erosion and \nepithelial regenerative changes. \n___ year old man with several days of nausea, vomiting, and \nepigastric pain, found to have pancreatic lesion & CBD \ndilatation. Patient was admitted for ERCP and MRCP to evaluate a \npancreatic mass found on imaging at an outside hospital.\n\n# Hematemesis: Had episode of coffee ground emesis on ___. \nHematocrit remained stable. He was started on an IV PPI.\n \n# Pancreatic lesion/CBD dilation: Appears cystic though concern \nfor malignancy as well. Based on MRCP findings, the lesion is \ncystic. Brushings of the CBD showed atypical glandular cells. \nThis will require further evaluation to ensure there is no \nmalignancy. \n\n# Hypertension: Well controlled at this time. The patient's \nblood pressure medications were stopped in the setting of \nhematemesis, blood pressures remained well controlled.\n\nTRANSITIONAL ISSUES:\n- Stopped Lisopril-HCTZ and Labetalol on d/c due to well \ncontrolled blood pressures holding on medications in-house. \nRestarted Doxazosin to prevent urinary retention. Consider \nrestarting other meds and possibly changing Doxazosin to \nTamsulosin if would like him on renally protective Lisinopril\n- Follow up per GI for further evaluation"}}
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{'final_diagnoses': ['- 1.3 cm cystic pancreatic head mass', '- Biliary obstruction', '- Hypertension', '- Non insulin dependent diabetes mellitus', '- Hyperlipidemia'], 'procedures': ['___: ERCP with sphincterotomy and brushings', '___: MRCP'], 'visit_summary': "___ year old man with several days of nausea, vomiting, and \nepigastric pain, found to have pancreatic lesion & CBD \ndilatation. Patient was admitted for ERCP and MRCP to evaluate a \npancreatic mass found on imaging at an outside hospital.\n\n# Hematemesis: Had episode of coffee ground emesis on ___. \nHematocrit remained stable. He was started on an IV PPI.\n \n# Pancreatic lesion/CBD dilation: Appears cystic though concern \nfor malignancy as well. Based on MRCP findings, the lesion is \ncystic. Brushings of the CBD showed atypical glandular cells. \nThis will require further evaluation to ensure there is no \nmalignancy. \n\n# Hypertension: Well controlled at this time. The patient's \nblood pressure medications were stopped in the setting of \nhematemesis, blood pressures remained well controlled.\n\nTRANSITIONAL ISSUES:\n- Stopped Lisopril-HCTZ and Labetalol on d/c due to well \ncontrolled blood pressures holding on medications in-house. \nRestarted Doxazosin to prevent urinary retention. Consider \nrestarting other meds and possibly changing Doxazosin to \nTamsulosin if would like him on renally protective Lisinopril\n- Follow up per GI for further evaluation", 'medications_prescribed': ['1. Atorvastatin 10 mg PO DAILY', '2. Fluticasone Propionate NASAL 2 SPRY NU DAILY', '3. Doxazosin 4 mg PO HS', '4. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY', '5. Ranitidine 150 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 86, 'gender': 'M', 'symptoms': 'Abdominal pain', 'medical_history': ['PUD: asymptomatic duodenal ulcer since age ___ years ago', 'diagnosed with bleeding peptic ulcer', 'HTN', 'high cholesterol'], 'family_history': 'NC', 'present_illness': "___ year old who presented with stomach pains, beginning the \nmorning prior to presentation; patient believes pain worsened \nthrough day, pain is currently a ___ after self-treatment with \n4 servings of Amphojel ( aluminum hydroxide ) this afternoon. \nSymptoms were preceded by cessation of Omeprazole intake one \nweek ago, which resulted in diarrhea; and more immediately, \nreduced appetite and severe diarrhea starting ___ ( ___ ). \nPatient believes he had ___ episodes of diarrhea -- stools were \nnormal in color, without gross blood, ill-formed. Since the \nonset of diarrhea, patient's appetite has been significantly \ndecreased. Arrived at ED hypotensive with a systolic BP in the \n___ and hyperglycemia. No reported nausea or vomiting. Patient \ndoes admit to taking low dose aspirin (81 mg) for the past \nseveral years.", 'medications': [{'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetFORMIN XR (Glucophage XR)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Montelukast Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 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'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '231', 'valuenum': 231.0, 'valueuom': 'IU/L', 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'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 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'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals -- HR 99, RR 18, current BP 129/79, 02 sat 100 RA. \nPatient is alert and oriented by 3.\nCardiac exam shows RRR, lung exam shows clear lungs with no \nreported pain. \nAbdominal exam shows mildly distended abdomen, no pain on \npercussion, but pain on deep palpation of upper \nabdomen/epigastric region. Bowel sounds not appreciated in exam.', 'diagnoses': [{'icd_code': '5761', 'desc': 'Cholangitis'}, {'icd_code': '57451', 'desc': 'Calculus of bile duct without mention of cholecystitis, with obstruction'}, {'icd_code': '7907', 'desc': 'Bacteremia'}, {'icd_code': '1977', 'desc': 'Malignant neoplasm of liver, secondary'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '0413', 'desc': "Friedländer's bacillus infection in conditions classified elsewhere and of unspecified site"}, {'icd_code': '04104', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '501', 'desc': 'Asbestosis'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '2948', 'desc': 'Other persistent mental disorders due to conditions classified elsewhere'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'V1005', 'desc': 'Personal history of malignant neoplasm of large intestine'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}], 'summary': "___ 11:50PM BLOOD WBC-16.7*# RBC-5.40 Hgb-17.5 Hct-55.2* \nMCV-102* MCH-32.3* MCHC-31.6 RDW-15.0 Plt ___\n___ 11:50PM BLOOD Neuts-80* Bands-12* Lymphs-5* Monos-3 \nEos-0 Baso-0 ___ Myelos-0\n___ 02:00AM BLOOD ___ PTT-34.9 ___\n___ 12:08AM BLOOD Glucose-61* UreaN-53* Creat-2.2*# Na-140 \nK-5.9* Cl-106 HCO3-22 AnGap-18\n___ 05:15AM BLOOD ALT-39 AST-74* CK(CPK)-568* AlkPhos-58 \nAmylase-169* TotBili-1.6*\n___ 05:15AM BLOOD CK-MB-31* MB Indx-5.5 cTropnT-0.23*\n___ 05:15AM BLOOD Albumin-2.4* Calcium-8.4 Phos-2.8 Mg-1.6\n___ 03:00AM BLOOD WBC-17.0* RBC-3.37* Hgb-11.3* Hct-34.0* \nMCV-101* MCH-33.4* MCHC-33.1 RDW-15.3 Plt ___\n___ 03:00AM BLOOD ___ PTT-52.9* ___\n___ 03:00AM BLOOD Glucose-149* UreaN-66* Creat-2.8* Na-139 \nK-3.2* Cl-105 HCO3-20* AnGap-17\n___ 01:48AM BLOOD ALT-27 AST-41* CK(CPK)-246 AlkPhos-51 \nAmylase-372* TotBili-1.2\n___ 01:48AM BLOOD CK-MB-4 cTropnT-0.22*\n___ 03:00AM BLOOD Albumin-3.9 Calcium-8.2* Phos-2.3* Mg-2.4\n___ 11:43AM BLOOD Type-ART pO2-81* pCO2-50* pH-7.18* \ncalTCO2-20* Base XS--9\n\nCT abdomen -- suggests free fluid in abdomen, gastric outlet \nobstruction, and air foci. Suspicious for perforated duodenal \nulcer.\nMr. ___ was evaluated in the emergency department by the \ngeneral surgery service. He had a CT scan demonstrating \npneumoperitoneum and peritonitis concerning for a duodenal \nperforation, and he was hypotensive in the ED. The decision was \nmade to take him emergently to the OR for exploratory \nlaparotomy. In the OR, he was found to have a perforated \nduodenal ulcer with gross contamination of the peritoneal \ncavity. The perforation was repaired and G and J tubes were \nplaced. He was placed on broad spectrum antibiotics and \ntransferred to the TICU intubated and sedated.\n\nNeuro: He remained neurologically intact. He pain was managed \nwith fentanyl and he was sedated with versed.\n\nRespiratory: He remained intubated in the TICU post-op for his \nrespiratory failure. There was increasing difficulty with \noxygenation despite multiple modes of ventilation attempted.\n\nCV: The patient's blood pressure remained labile. He required \ncopious amounts of IV fluid to help maintain his pressure as \nwell as pressor support. Postoperatively he developed new onset \natrial fibrillation with rapid ventricular response. He was \ncardioverted x2 without a significant improvement in his \npressure. Diltiazem drip was started to help control his rate.\n\nRenal: He developed acute renal failure postoperatively. He \nremained essentially anuric despite ample resuscitation. Renal \nwas consulted and they had not initiated the start of dialysis.\n\nGI: The patient's abdomen became more distended and tense over \nthe course of his stay concerning for abdominal compartment \nsyndrome. G and J tubes remained open to gravity. Bladder \npressures and exam were monitored closely. On POD 4, the patient \nwas paralyzed with improvement of his bladder pressures.\n\nID: He remained on broad spectrum antibiotics (zosyn, \nfluconazole) throughout his course.\n\nDespite all resucitative efforts, the patient remained in \nmulti-system organ failure. He became more and more difficult to \noxygenate and began to desaturate on POD4. Discussions were held \nwith his next of kin who decided that the patient would not want \nfurther heroic measures in the face of his prognosis and his was \nmade DNR. Later that day the patient went into cardiac arrest \nand was pronounded at 1329 on ___."}}
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{'final_diagnoses': ['Perforated duodenal ulcer', 'Sepsis', 'Renal failure', 'Repiratory failure', 'Atrial Fibrillation'], 'procedures': ['___', 'Exploratory laparotomy', '___ patch repair of perforated \nduodenal ulcer', 'G-tube placement', 'J-tube placement'], 'visit_summary': "Mr. ___ was evaluated in the emergency department by the \ngeneral surgery service. He had a CT scan demonstrating \npneumoperitoneum and peritonitis concerning for a duodenal \nperforation, and he was hypotensive in the ED. The decision was \nmade to take him emergently to the OR for exploratory \nlaparotomy. In the OR, he was found to have a perforated \nduodenal ulcer with gross contamination of the peritoneal \ncavity. The perforation was repaired and G and J tubes were \nplaced. He was placed on broad spectrum antibiotics and \ntransferred to the TICU intubated and sedated.\n\nNeuro: He remained neurologically intact. He pain was managed \nwith fentanyl and he was sedated with versed.\n\nRespiratory: He remained intubated in the TICU post-op for his \nrespiratory failure. There was increasing difficulty with \noxygenation despite multiple modes of ventilation attempted.\n\nCV: The patient's blood pressure remained labile. He required \ncopious amounts of IV fluid to help maintain his pressure as \nwell as pressor support. Postoperatively he developed new onset \natrial fibrillation with rapid ventricular response. He was \ncardioverted x2 without a significant improvement in his \npressure. Diltiazem drip was started to help control his rate.\n\nRenal: He developed acute renal failure postoperatively. He \nremained essentially anuric despite ample resuscitation. Renal \nwas consulted and they had not initiated the start of dialysis.\n\nGI: The patient's abdomen became more distended and tense over \nthe course of his stay concerning for abdominal compartment \nsyndrome. G and J tubes remained open to gravity. Bladder \npressures and exam were monitored closely. On POD 4, the patient \nwas paralyzed with improvement of his bladder pressures.\n\nID: He remained on broad spectrum antibiotics (zosyn, \nfluconazole) throughout his course.\n\nDespite all resucitative efforts, the patient remained in \nmulti-system organ failure. He became more and more difficult to \noxygenate and began to desaturate on POD4. Discussions were held \nwith his next of kin who decided that the patient would not want \nfurther heroic measures in the face of his prognosis and his was \nmade DNR. Later that day the patient went into cardiac arrest \nand was pronounded at 1329 on ___.", 'medications_prescribed': ['N/A']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'M', 'symptoms': 'LLE pain', 'medical_history': ['DM', 'nephrolithiasis', 'diabetic retinopathy', 'obesity', 'dyslipidemia', 'hypertension'], 'family_history': 'Non-contributory', 'present_illness': 'HPI:\nMr. ___ is a ___ who has a significant past vascular surgical\nhistory of multiple toe amputations, L TMA and bilateral \nbypasses who presents with acute onset LLE pain associated with \ncoolness in the LLE. The symptoms started 2 days ago and have \nbeen progressively worsening. Initially the pain was with \nexertion in the foot extending to the mid shin. Now he is \ncomplaining that his foot is constantly sore and tender. As a \nresult, he has decreased mobility (previously he was able to\nwalk distances with cane assistance). He presented to the ED for \nevaluation. Of note, he was last evaluated by Dr. ___ \non ___ with surveillance duplex which demonstrated a patent \nbilateral graft with slightly decreased flow on the left \n(unchanged).', 'medications': [{'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83.3', 'valuenum': 83.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '314', 'valuenum': 314.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.92', 'valuenum': 4.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 598.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 500.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IN AMBULATORY PATIENTS WITH LOW PRE-TEST PROBABILITY (WELLS CRITERIA),;D-DIMER <500 CAN BE USED TO EXCLUDE VENOUS THROMBOEMBOLIC DISEASE.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 192.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 177.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYZED SPECIMEN.'}, {'value': '___', 'valuenum': 24.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '291', 'valuenum': 291.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '307', 'valuenum': 307.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 268.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '296', 'valuenum': 296.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 308.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.16, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '295', 'valuenum': 295.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES P..'}, {'value': '___', 'valuenum': 7.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '291', 'valuenum': 291.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.69', 'valuenum': 4.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 174.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Alert and oriented x 3 \nVS:BP 128/74 HR 66 \nCarotids: 2+, no bruits or JVD\nResp: Lungs clear\nAbd: Soft, non tender\nExt: Pulses: Left Femoral p, DP d ,___ d\n Right Femoral p, DP p ,___ p\nFeet warm, well perfused. No open areas through dry dry and \nscaly.\nRight groin puncture site: Soft, no hematoma or ecchymosis.', 'diagnoses': [{'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '41189', 'desc': 'Other acute and subacute forms of ischemic heart disease, other'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '37950', 'desc': 'Nystagmus, unspecified'}, {'icd_code': '7813', 'desc': 'Lack of coordination'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '7234', 'desc': 'Brachial neuritis or radiculitis NOS'}, {'icd_code': '7812', 'desc': 'Abnormality of gait'}, {'icd_code': '79319', 'desc': 'Other nonspecific abnormal finding of lung field'}, {'icd_code': '6961', 'desc': 'Other psoriasis'}, {'icd_code': '60784', 'desc': 'Impotence of organic origin'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '78057', 'desc': 'Unspecified sleep apnea'}, {'icd_code': '69010', 'desc': 'Seborrheic dermatitis, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '29680', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '78605', 'desc': 'Shortness of breath'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': '7295', 'desc': 'Pain in limb'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}], 'summary': '___ 07:00AM BLOOD WBC-8.3 RBC-3.70* Hgb-10.9* Hct-33.5* \nMCV-90 MCH-29.5 MCHC-32.7 RDW-13.4 Plt ___\n___ 07:20AM BLOOD ___ PTT-86.9* ___\n___ 07:20AM BLOOD Glucose-247* UreaN-26* Creat-1.4* Na-137 \nK-4.4 Cl-98 HCO3-31 AnGap-12\n___ 03:30PM BLOOD ALT-16 AST-15 AlkPhos-63 TotBili-1.5\n___ 07:20AM BLOOD Calcium-9.1 Phos-3.9 Mg-2.2\n___ 06:00PM BLOOD %HbA1c-10.5* eAG-255*\nMr ___ was admitted through the emergency room for complaints \nof left leg pain. He was started on a heparin drip then taken \nto the endovascular suite for thromboslysis. He was found to \nhave thrombosed vein graft coming off the left\nabove knee popliteal artery. There was a short entrance ramp \nthat was clearly thrombosed. He was then maintained on a \nheparin drip overnight as well as tPA infusion through the \ncatheter overnight. He was brought back to the angio suite for \nlysis check the following morning. He was found to have \nresidual thrombus. He was given a hand injection of tPA into \nthe region of the distal graft anastomosis and a stent was \nplaced in the DP. He was returned to the floor with tPA via the \ncatheter and heparin infusion. He returned to the endo-suite \nlater that same day. This angio demonstrated a patent bypass \ngraft and stent with significantly improved outflow into his \ndorsalis pedis and lateral tarsal with filling of the distal \nbranches of his foot so the catheter was discontinued. \n\nHe was kept on a heparin drip and was also started on coumadin \nand plavix. He was maintained on the heparin until his INR \ngreater than 2 which occured on the day of discharge. \n\nHe was followed by the ___ Diabetes service while in house \nfor blood sugar management as his A1c was 10.5 on admission. \nHis sliding scale insulin was adjusted. \n\nHe worked with ___ and was cleared for discharge to home. He has \nfollow up arranged with his PCP for INR check tommorrow. He \nwill return in one month for surveillance duplex.'}}
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{'final_diagnoses': ['Critical ischemic left leg', 'Peripheral Arterial Disease', 'Diabetes'], 'procedures': ['___ AngioJet thrombectomy of the popliteal artery and \nabove-knee popliteal-to-dorsalis pedis vein graft', 'Percutaneous transluminal angioplasty of the vein graft', 'Placement of a ___ catheter for overnight lysis', '___ngiography with TPA hand injection and \nstent placement', '___ngiography, catheter removal'], 'visit_summary': 'Mr ___ was admitted through the emergency room for complaints \nof left leg pain. He was started on a heparin drip then taken \nto the endovascular suite for thromboslysis. He was found to \nhave thrombosed vein graft coming off the left\nabove knee popliteal artery. There was a short entrance ramp \nthat was clearly thrombosed. He was then maintained on a \nheparin drip overnight as well as tPA infusion through the \ncatheter overnight. He was brought back to the angio suite for \nlysis check the following morning. He was found to have \nresidual thrombus. He was given a hand injection of tPA into \nthe region of the distal graft anastomosis and a stent was \nplaced in the DP. He was returned to the floor with tPA via the \ncatheter and heparin infusion. He returned to the endo-suite \nlater that same day. This angio demonstrated a patent bypass \ngraft and stent with significantly improved outflow into his \ndorsalis pedis and lateral tarsal with filling of the distal \nbranches of his foot so the catheter was discontinued. \n\nHe was kept on a heparin drip and was also started on coumadin \nand plavix. He was maintained on the heparin until his INR \ngreater than 2 which occured on the day of discharge. \n\nHe was followed by the ___ Diabetes service while in house \nfor blood sugar management as his A1c was 10.5 on admission. \nHis sliding scale insulin was adjusted. \n\nHe worked with ___ and was cleared for discharge to home. He has \nfollow up arranged with his PCP for INR check tommorrow. He \nwill return in one month for surveillance duplex.', 'medications_prescribed': ['1. Amlodipine 10 mg PO DAILY', '2. Aspirin 81 mg PO DAILY', '3. Docusate Sodium 100 mg PO BID constipation', '4. Doxazosin 2 mg PO HS', '5. Hydrochlorothiazide 25 mg PO DAILY', '6. Metoprolol Tartrate 75 mg PO BID', '7. Rosuvastatin Calcium 40 mg PO DAILY', '8. Humalog ___ 38 Units Breakfast\nHumalog ___ 42 Units Dinner', '9. Warfarin 7.5 mg PO DAILY \nRX *warfarin [Coumadin] 7.5 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*0', '10. Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', '11. MetFORMIN (Glucophage) 1000 mg PO BID', '12. Losartan Potassium 100 mg PO DAILY', '13. Vitamin D 1000 UNIT PO DAILY', '14. Bisacodyl 10 mg PO DAILY:PRN constipation', '15. Acetaminophen 1000 mg PO Q8H']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 70, 'gender': 'M', 'symptoms': 'fall', 'medical_history': ['PMH: none', 'PSH: none'], 'family_history': 'noncontributory', 'present_illness': 'Mr. ___ is a ___ with no reported PMHx presenting as \ntrauma transfer from a hospital in ___. The patient fell two \nstories into empty pool on ___ and admitted to hospital in \n___. Had positive FAST exam in the ER and underwent ex-lap in \nOR on ___ with finding of "mesenteric perforation" that was \nrepaired. In recovery room, he had increased abdominal girth and \nrespiratory distress and admitted to ICU.\n\nHospital course in ___ summarized by systems:\n-Neuro: very agitated, no head CT possible. Reportedly able to \nfollow commands. On ___, found to be anisocoric & febrile - \ngiven mannitol and Lasix with improvement. Also treated for \nmeningitis.\n-CV: HD stable until ___ when NGT output became bloody and \npatient became hypotensive requiring first dopamine then \naddition of levophed (septic vs. hemorrhagic shock) - eventually \nweaned off prior to transfer\n-Pulm: intubated (___), extubated to NRB (___), \nre-intubated ___, extubated to BIPAP (___), re-intubated \n___. Sputum pink & frothy, occasionally blood. Thought to have \nPE post-op but never treated. CXR showed pulm edema & small \npleural effusions. Treated for aspiration PNA.\n-GI: endoscopy ___ showed severe gastric hemorrhage - nexium \ngtt from ___. NPO since admission, no TPN. Instead recieved \n10% amino acid solution 1L/day (___\n-Renal: dailysis for electrolyte abnormalities, uremia & \noliguria\n-Heme: coffee ground emesis & melena. Also bleeding from ETT as \nwell as otorrhea. Received total of 10 PRBC and ___ FFP. On day of \ntransfer, Hct 17 and platelets 43. Had bleeding from groin after \nremoval of HD catheter\n-Endo: normoglycemic with episodes of hypoglycemia\n-ID: received multiple of antibiotics (cefazolin, Flagyl, \nceftriaxone, vanco, clindamycin, gentamicin) for post-op \ninfection, meningitis, and sepsis\n- Lines: double lumen LIJ (___) to triple lumen (___), R \nfemoral dialysis cathered (___\n-Skin: Stage I sacral decub\n\nHe was transferred out of ___ on ___. Coded in flight (5 \nmin) requiring landing in ___ also cardiac coded en route \nfrom airport to hospital (2 min) with ROSC. Both events were \ncardiac codes (bradycardia). He was admitted to ___ \n___. CT head and C-spine showed C1 burst fracture, C6 \nlamina fracture, no intracranial hemorrhage, left lacunar \ninfarcts, extensive sinonasal disease (opacification of frontal \nsinuses, sphenoid snus, right max sinus, ethmoid air cells).\n\nHe was subsequently transferred via medflight to ___ for \nfurther management.', 'medications': [{'medication': 'Amoxicillin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Amoxicillin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Gentamicin 0.3% Ophth. Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'benazepril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '39.0', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.35', 'valuenum': 4.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = 74 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 198.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LESS THAN 5.'}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '493', 'valuenum': 493.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '427', 'valuenum': 427.0, 'valueuom': 'mg/dL', 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'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.24', 'valuenum': 4.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '1.005', 'valuenum': 1.005, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '315', 'valuenum': 315.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 200.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '322', 'valuenum': 322.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.005', 'valuenum': 1.005, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.2, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66.4', 'valuenum': 66.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.34', 'valuenum': 4.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65.0', 'valuenum': 65.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.3,. Estimated GFR = 55 if non African-American (mL/min/1.73 m2). Estimated GFR = 66 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.3', 'valuenum': 41.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.2', 'valuenum': 46.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '56.6', 'valuenum': 56.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.53', 'valuenum': 4.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60.2', 'valuenum': 60.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '54.8', 'valuenum': 54.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '68.3', 'valuenum': 68.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74.4', 'valuenum': 74.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66.1', 'valuenum': 66.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '73.1', 'valuenum': 73.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '71.9', 'valuenum': 71.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '286', 'valuenum': 286.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '407', 'valuenum': 407.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "ADMISSION PHYSICAL EXAM:\nVS - Afebrile HR: 87 BP: 132/64 RR: 16 100% PSV\nGeneral: Unresponsive, intubated, sedated\nHEENT: C-collar in place\nNeck: Supple\nCV: RRR\nLungs: CTAB\nAbdomen: Well healing midline incision, soft\nGU: Foley in place\nExt: Warm, diffuse edema in all extremities\nNeuro: PERRL, unresponsive to voice or noxious stimuli\nSkin: Warm.\n\nDISCHARGE PHYSCIAL EXAM:\nVS: 98.1, 95, 131/85, 22, 100%TM\nGeneral: NAD, trach in place, breathing comfortably. \nHEENT: Hard collar in place. Trach site CDI. \nCV: HRR, intermittently sinus tach to 110's \nLungs: Junky. coughs up large amounts of thin clear secretions, \nrequires frequent suctioning. Oxygen 100% on trach mask. \nAbdomen: Well healed midline incision, soft. J-tube site CDI.\nGU: Condom-catheter in place\nExt: Warm, trace pedal edema. Left PICC line. air boots to BLE.\n Neurologic: \n -Mental Status: Awake, looks at examiner, makes good eye \ncontat, tracks well. No verbal output. Does not seem to follow \nany commands. \n -Cranial Nerves: PERRL 1.5-1, sluggish. Gaze conjugate. Face \nsymmetric. \n -Motor: Few spontaneous movements with distal upper \nextremities, RUE>LUE. No purposeful movements. Tone is \nlow-normal throughout. \n-Sensory: No response to noxious stim throughout", 'diagnoses': [{'icd_code': '2273', 'desc': 'Benign neoplasm of pituitary gland and craniopharyngeal duct'}, {'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '45342', 'desc': 'Acute venous embolism and thrombosis of deep vessels of distal lower extremity'}, {'icd_code': '37751', 'desc': 'Disorders of optic chiasm associated with pituitary neoplasms and disorders'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '7813', 'desc': 'Lack of coordination'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '4733', 'desc': 'Chronic sphenoidal sinusitis'}, {'icd_code': '37851', 'desc': 'Third or oculomotor nerve palsy, partial'}, {'icd_code': '4718', 'desc': 'Other polyp of sinus'}, {'icd_code': '37820', 'desc': 'Intermittent heterotropia, unspecified'}, {'icd_code': '37300', 'desc': 'Blepharitis, unspecified'}, {'icd_code': '37230', 'desc': 'Conjunctivitis, unspecified'}, {'icd_code': '3669', 'desc': 'Unspecified cataract'}, {'icd_code': '25002', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}, {'icd_code': '2530', 'desc': 'Acromegaly and gigantism'}], 'summary': 'Admission Labs:\n___ 12:00AM BLOOD WBC-11.7* RBC-2.27* Hgb-6.5* Hct-19.1* \nMCV-84 MCH-28.6 MCHC-34.0 RDW-16.4* RDWSD-49.1* Plt Ct-23*\n___ 12:00AM BLOOD ___ PTT-24.1* ___\n___ 12:00AM BLOOD Glucose-104* UreaN-172* Creat-8.7* Na-144 \nK-4.5 Cl-99 HCO3-16* AnGap-34*\n___ 02:00PM BLOOD ALT-132* AST-143* AlkPhos-148* \nTotBili-1.2\n___ 12:00AM BLOOD Calcium-5.0* Phos-10.7* Mg-2.4\n___ 12:12AM BLOOD Type-CENTRAL VE Temp-36.8 PEEP-5 FiO2-40 \npO2-168* pCO2-29* pH-7.36 calTCO2-17* Base XS--7 \nIntubat-INTUBATED\n\nDischarge Labs:\n___ 10:00AM BLOOD WBC-11.3* RBC-2.82* Hgb-7.9* Hct-24.5* \nMCV-87 MCH-28.0 MCHC-32.2 RDW-13.2 RDWSD-41.3 Plt ___\n___ 10:00AM BLOOD WBC-10.8* RBC-2.72* Hgb-7.7* Hct-23.8* \nMCV-88 MCH-28.3 MCHC-32.4 RDW-13.1 RDWSD-41.4 Plt ___\n___ 09:00AM BLOOD WBC-10.8* RBC-2.87* Hgb-8.2* Hct-25.2* \nMCV-88 MCH-28.6 MCHC-32.5 RDW-13.2 RDWSD-41.8 Plt ___\n___ 09:20AM BLOOD WBC-10.5* RBC-2.82* Hgb-8.0* Hct-24.4* \nMCV-87 MCH-28.4 MCHC-32.8 RDW-13.0 RDWSD-40.7 Plt ___\n___ 10:00AM BLOOD Glucose-111* UreaN-34* Creat-1.4* Na-131* \nK-5.3* Cl-95* HCO3-24 AnGap-17\n___ 10:00AM BLOOD Glucose-124* UreaN-10 Creat-1.1 Na-135 \nK-4.8 Cl-105 HCO3-22 AnGap-13\n___ 09:00AM BLOOD Glucose-112* UreaN-12 Creat-1.1 Na-134 \nK-4.5 Cl-104 HCO3-22 AnGap-13\n___ 09:20AM BLOOD Glucose-115* UreaN-12 Creat-1.2 Na-137 \nK-4.3 Cl-104 HCO3-23 AnGap-14\n___ 06:20AM BLOOD ALT-76* AST-52* AlkPhos-208* Amylase-312* \nTotBili-0.4\n___ 06:59AM BLOOD ALT-90* AST-71* AlkPhos-204*\n___ 04:50AM BLOOD ALT-88* AST-72* AlkPhos-213*\n___ 01:54AM BLOOD ALT-68* AST-69* AlkPhos-193* TotBili-1.0\n___ 10:00AM BLOOD Calcium-9.4 Phos-2.6* Mg-2.2\n___ 10:00AM BLOOD Calcium-9.1 Phos-2.3* Mg-1.7\n___ 09:00AM BLOOD Calcium-9.2 Phos-2.9 Mg-1.9\n___ 09:20AM BLOOD Calcium-9.5 Phos-3.1 Mg-1.8\n\nImaging:\nCT head ___\n1. No evidence of acute intracranial abnormality.\n2. Large bilateral subgaleal fluid collection, possibly chronic \nsubgaleal hematoma.\n3. Opacification of the paranasal sinuses, mastoid air cells and \nmiddle ear\ncavities likely relates to long-term intubation.\n4. Notable retained secretions in the nasopharynx.\n\nMRI head ___\n1. There is no evidence of acute intracranial process or \nhemorrhage. There\nis no evidence of mass effect or shifting of the normally \nmidline structures. \nNo diffusion abnormalities are detected.\n2. Opacification of the paranasal sinuses, mastoid air cells \nand middle ear\ncavities, probably is related to long-term intubation.\n3. Scattered foci of high signal intensity distributed in the \nsubcortical and periventricular white matter, detected on T2 and \nFLAIR sequences, are\nnonspecific and may reflect changes due to small vessel disease.\n4. The fracture at the level of C1 level is better depicted in \nthe concurrent\nCT of the cervical spine, please refer to that report for more \ndetails.\n\nCT C-spine ___\n1. Burst fracture of C1. Fracture of the right pedicle and \nlamin of C6.\n2. No evidence of central canal narrowing.\n3. Significant retained secretions in the ___ and oropharynx.\n\nMRI C-spine ___\n1. Unchanged burst fracture of C1 vertebral body, better \ndepicted\nin the concurrent CT of the cervical spine.\n \n2. The signal intensity throughout the cervical spinal cord is \nnormal with no\nevidence of focal or diffuse lesions, there is no evidence of \ncord expansion\nor intra medullary hemorrhage.\n \n3. Soft tissue edema is identified in the interspinous ligament \nat C2/C3\nlevel an anterior to the odontoid process.\n \n4. Endotracheal tube appears in place, enteric tube is seen in \nthe esophagus.\nSignificant amount of retained secretions are visualized in the \noropharynx.\n\nCTA Neck ___\n1. C1 and C6 fractures are better assessed on recent prior CT of \nthe cervical spine, and are not significantly changed.\n2. Carotid and vertebral arteries are patent, with no evidence \nof dissection or vascular injury.\n3. Partially visualized biapical pulmonary opacities and large \nbilateral pleural effusions suggest pneumonia or aspiration, and \nare better assessed on prior CT of the torso from earlier today.\n\nCT Torso ___\n1. Large bilateral pleural effusions with near complete collapse \nof bilateral\nlower lobes.\n2. Bilateral lung opacities and areas of nonenhancement within \natelectatic\nlower lobes suggests pneumonia or aspiration.\n3. Delayed enhancement of the kidneys compatible with known \nrenal failure.\n4. Thrombosis in bilateral lower extremity deep veins as \ndetailed above. \nThrombus is also seen in the left common femoral vein.\n5. Severe anasarca and large bilateral hydroceles suggest fluid \noverload.\n\nEEG ___\nThis is an abnormal continuous ICU monitoring study because of \nthe presence of prolonged runs of generalized periodic \ndischarges that are initially blunted and broad-based, evolve \ninto higher amplitude sharp and slow wave discharges. These \ngeneralized periodic discharges occur in runs reaching up to a \nfrequency of 1 Hz. These do not evolve into electrographic \nseizures and there is no definite clinical correlate. After \n18:30, coinciding with administration of lorazepam and \nphenytoin, discharges are seen only occasionally in briefer runs \nof up to ___ seconds at a frequency of one every two to five \nseconds. These findings indicate highly epileptogenic cortex in \nthe left and right hemispheres. Between the discharges, a \nsymmetric delta background is present with brief two to three \nsecond bursts of generalized attenuation which is indicative of \na severe encephalopathy that is non-specific with regards to \netiology.\n\nLower extremity venous duplex ___\n1. Limited evaluation of the left deep femoral vein ; it is not \nfully compressible, thrombus is not excluded.\n2. Though known left sided venous thrombus is not definitive \nvisualized, there is dampening of left-sided venous waveforms, \nconsistent with upstream thrombus.\n3. No evidence of deep venous thrombosis in the right lower \nextremity.\n\nRenal ultrasound ___\nEchogenic kidneys consistent with medical renal disease. Right \nrenal cyst. No hydronephrosis bilaterally.\n\n___ C-Spine CT\n1. Interval lateral subluxation of the bilateral lateral \nelements of C1, with worsened distraction of the right anterior \narch and left posterior arch fracture fragments, and subluxation \nof the craniocervical junction relative to C2 compared with CT \nC-spine on ___. The degree of subluxation C1-C2 \noffset at measures approximately 1.1 cm. The atlantodental \ninterval is preserved. \n2. There does not appear to be significant narrowing of the \ncraniocervical \njunction and no mass effect on the brainstem more cord. There \nis no basilar invagination. MRI cervical spine is recommended \nfor further evaluation as clinically indicated. \n3. No significant change in nondisplaced C6 right pedicle lamina \nfracture. \n\nBAL ___\nACINETOBACTER BAUMANNII COMPLEX | \nAMPICILLIN/SULBACTAM-- 16 I\nCEFEPIME-------------- =>64 R\nCEFTAZIDIME----------- =>64 R\nCIPROFLOXACIN--------- =>4 R\nGENTAMICIN------------ =>16 R\nLEVOFLOXACIN---------- =>8 R\nMEROPENEM------------- 0.5 S\nTOBRAMYCIN------------ =>16 R\nTRIMETHOPRIM/SULFA---- =>16 R\n\n KLEBSIELLA PNEUMONIAE\n | PSEUDOMONAS AERUGINOSA\n | | \nAMIKACIN-------------- 4 S\nAMPICILLIN/SULBACTAM-- =>32 R\nCEFAZOLIN------------- =>64 R\nCEFEPIME-------------- 2 S 8 S\nCEFTAZIDIME----------- 16 R 32 R\nCEFTRIAXONE----------- =>64 R\nCIPROFLOXACIN--------- 2 I <=0.25 S\nGENTAMICIN------------ =>16 R <=1 S\nMEROPENEM-------------<=0.25 S 1 S\nPIPERACILLIN/TAZO----- 16 S R\nTOBRAMYCIN------------ =>16 R <=1 S\nTRIMETHOPRIM/SULFA---- =>16 R\n___ presenting as transfer from ___ s/p 2 story fall \nsustaining C1/C6 fractures and mesenteric perforation with \ncourse complicated by septic/hypovolemic shock, acute renal \nfailure requiring HD, and cardiac arrest x2 on transport to \n___ now with no spontaneous movement off sedation. The \nfollwoing events summarized his ___ hospital course\n\n#Neuro: Seizures/Anoxic brain injury\nOn arrival to ___ patient was unresponsive, pupils 4->3mm and \nbriskly reactive bilaterally, and had no extremity movement to \nnoxious stimuli. EEG was obtained on ___ which showed severe \nencephalopathy and presence of prolonged runs of generalized \nperiodic discharges consistent with seizure activity. Patient \nwas loaded with 2mg Dilantin and given Ativan. Neurology consult \nwas obtained. Dilantin/Free Dilantin/Albumin levels were \nmonitored throughout his hospital course with goal corrected \ndilantin level ___. His neuro exam continued to be poor \nthroughout his hospital course and it was felt that his \nneurological prognosis for meaningful recovery is very poor. \n\n#Pulmonary: Resp failure: s/p tracheostomy ___\nPatient arrived already intubated at OSH. Bronchosocpy was \nperformed on arrival which showed severe destruction of his \nupper airway membranes concerning for CMV infection. He was \ninitially started on gangcyclovir/vancomycin/cefepime. BAL \ncultures showed acinetobacter, klebsiella, and pseudomonas \ngrowth. Due to persistent respiratory failure, patient underwent \nPEG ___. He was subsequently able to tolerate trach mask. \n\n#Cardiac: cardiac arrest x2 on transport from ___\nPatient required pressors on arrival to the ICU. Pressors were \nsubsequently weaned over the next few day after resuscitation. \nHe remained hemodynamically stable throughout the rest of his \nhospital course. \n\n# ___\nPatient is s/p exploratory laparotomy on ___ in ___ with \nrepair of a "mesenteric perforation." PEG was placed ___. \nPatient was continued on tube feeds throughout the hospital \ncourse (Nepro @45)\n\n# Renal: renal failure requiring HD\nPatient was started on RRT via femoral catheter in ___ and HD \non ___ likely secondary to ischemic ATN from \nhypotension/sepsis. Cr was 8.7 on admssion. He had hematuria on \narrival which cleared after continuous bladder irrigation. Right \nfemoral HD line was placed and used from ___. A right IJ \ndialysis catheter was placed ___. Nephrology followed closely \nthroughout his hospitalization. Intermitted HD (WMF) was \ncontinued throughout his hospital course.\n\n# Heme, DVT\nPer OSH reports, patient had coffee ground emesis and melana and \nhas been transfused 10u pRBC and 9U of FFP prior to transfer. On \narrival, Hct was 19 and patient received 2U of pRBC. Patient \nreceived a total of 6 pRBCs intermittently throughout his \nhospital stay. CT torso revealed DVT within the left common \niliac vein, common femoral vein extending into the left deep \nfemoral vein. Argatroban gtt was initially started given concern \nfor HITT (admission Plt 23). HITT assay was subsequently \nnegative and patient was started on a heparin gtt. IVC filter \nwas placed on ___ given continued Hct drops and intermittent \nconcerns for bleeding on anticoagulation. \n\n# Trauma cervical spine injury \nPatient was found to have a C1 burst fracture and C6 lamina \nfracture on imaging. MRI and CTA of c-spine showed no evidence \nof carotid/vertebral artery injury and no cervical cord injury. \nOrthopaedic spine surgery was consulted. His fractures are \npotentially unstable fractures that would benefit from from \nsurgical stabilization, but given his poor neurological \nprognosis, surgery was deferred. C-collar was placed and secured \nfor cervical spine stabilization. \n\n# Pneumonia:\nPer report, patient received multiple antibiotics prior to \nadmission including cefazolin (___), Flagyl (___), \nceftriaxone (___), vanco (___), clindamycin \n(___), gentamicin ___ with HD) for post-op \ninfection, meningitis, and sepsis. Patient was found to have \nacinotobacter, klebsiella, and pseudomonas growth on admission \nBAL. His hospitalization antibiotic course is as follows:\nVancomycin ___ ), cefepime (___), gancyclovir Post \nHD (___). Meropenem (___), Cipro for meropenem \nresistant psuedomonas ___ - ___\n\nOn HD31 the patient was transferred out of the ICU to the \nsurgical floor, where he remained stable throughout the \nremainder of his hospitalization. Renal continued to follow and \nthe patient received intermittent hemodialysis. By HD46, the \npatient\'s urine output was appropriate, electrolytes acceptable, \ncreatinine improving, and BUN was stable, so HD was stopped. \nNeurology continued to follow the patient and a repeat brain MRI \non ___ showed no acute intracranial abnormality and progressive \nsupratentorial white matter lesions. Neurology felt it was \nunlikely he would make significant improvements with time. Per \nOrtho Spine, a repeat CT was obtained to evaluate the C1 and C6 \nfractures. The fractures still appeared unstable, therefore \nOrtho Spine recommended keeping the hard cervical collar and \ncommented that surgery was unlikely to be considered helpful \ngiven the limited benefit and considerable risk. On ___, \nthe patient went to Interventional Radiology to have his gastric \ntube switched over to a jejunal feeding tube. His tube feeds \nwere resumed which he was tolerating well. Coumadin was stopped \non ___ after the course was complete for treatment of DVT. The \npatient was only given subcutaneous heparin for DVT prophylaxis. \nThe patient\'s family was applying for ___ and the patient \nwas stable while awaiting for ___ to go through.\n\nAt the time of discharge, the patient was medically stable, \nafebrile with stable vital signs. The patient was tolerating \ntube feeds, out of bed with max-assist and total care with his \nADL\'s, voiding without assistance via condom catheter, and was \nintermittently agitated / in mitt restraints. He was requiring \nintermittent suctioning for moderate secretions. The patient \nwas discharged to rehab. The patient and family received \ndischarge teaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan. He had \nfollow-up scheduled with Spine and Neurology.'}}
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{'final_diagnoses': ['C1 burst fracture, C6 lamina fracture', 'Thrombosis in bilateral lower extremity veins', 'Acute toxic-metabolic encephalopathy', 'Acute kidney injury'], 'procedures': ['___: exploratory laparotomy (___)', '___: IVC filter placement', '___: percutaneous tracheostomy, percutaneous endoscopic \ngastrostomy'], 'visit_summary': '___ presenting as transfer from ___ s/p 2 story fall \nsustaining C1/C6 fractures and mesenteric perforation with \ncourse complicated by septic/hypovolemic shock, acute renal \nfailure requiring HD, and cardiac arrest x2 on transport to \n___ now with no spontaneous movement off sedation. The \nfollwoing events summarized his ___ hospital course\n\n#Neuro: Seizures/Anoxic brain injury\nOn arrival to ___ patient was unresponsive, pupils 4->3mm and \nbriskly reactive bilaterally, and had no extremity movement to \nnoxious stimuli. EEG was obtained on ___ which showed severe \nencephalopathy and presence of prolonged runs of generalized \nperiodic discharges consistent with seizure activity. Patient \nwas loaded with 2mg Dilantin and given Ativan. Neurology consult \nwas obtained. Dilantin/Free Dilantin/Albumin levels were \nmonitored throughout his hospital course with goal corrected \ndilantin level ___. His neuro exam continued to be poor \nthroughout his hospital course and it was felt that his \nneurological prognosis for meaningful recovery is very poor. \n\n#Pulmonary: Resp failure: s/p tracheostomy ___\nPatient arrived already intubated at OSH. Bronchosocpy was \nperformed on arrival which showed severe destruction of his \nupper airway membranes concerning for CMV infection. He was \ninitially started on gangcyclovir/vancomycin/cefepime. BAL \ncultures showed acinetobacter, klebsiella, and pseudomonas \ngrowth. Due to persistent respiratory failure, patient underwent \nPEG ___. He was subsequently able to tolerate trach mask. \n\n#Cardiac: cardiac arrest x2 on transport from ___\nPatient required pressors on arrival to the ICU. Pressors were \nsubsequently weaned over the next few day after resuscitation. \nHe remained hemodynamically stable throughout the rest of his \nhospital course. \n\n# ___\nPatient is s/p exploratory laparotomy on ___ in ___ with \nrepair of a "mesenteric perforation." PEG was placed ___. \nPatient was continued on tube feeds throughout the hospital \ncourse (Nepro @45)\n\n# Renal: renal failure requiring HD\nPatient was started on RRT via femoral catheter in ___ and HD \non ___ likely secondary to ischemic ATN from \nhypotension/sepsis. Cr was 8.7 on admssion. He had hematuria on \narrival which cleared after continuous bladder irrigation. Right \nfemoral HD line was placed and used from ___. A right IJ \ndialysis catheter was placed ___. Nephrology followed closely \nthroughout his hospitalization. Intermitted HD (WMF) was \ncontinued throughout his hospital course.\n\n# Heme, DVT\nPer OSH reports, patient had coffee ground emesis and melana and \nhas been transfused 10u pRBC and 9U of FFP prior to transfer. On \narrival, Hct was 19 and patient received 2U of pRBC. Patient \nreceived a total of 6 pRBCs intermittently throughout his \nhospital stay. CT torso revealed DVT within the left common \niliac vein, common femoral vein extending into the left deep \nfemoral vein. Argatroban gtt was initially started given concern \nfor HITT (admission Plt 23). HITT assay was subsequently \nnegative and patient was started on a heparin gtt. IVC filter \nwas placed on ___ given continued Hct drops and intermittent \nconcerns for bleeding on anticoagulation. \n\n# Trauma cervical spine injury \nPatient was found to have a C1 burst fracture and C6 lamina \nfracture on imaging. MRI and CTA of c-spine showed no evidence \nof carotid/vertebral artery injury and no cervical cord injury. \nOrthopaedic spine surgery was consulted. His fractures are \npotentially unstable fractures that would benefit from from \nsurgical stabilization, but given his poor neurological \nprognosis, surgery was deferred. C-collar was placed and secured \nfor cervical spine stabilization. \n\n# Pneumonia:\nPer report, patient received multiple antibiotics prior to \nadmission including cefazolin (___), Flagyl (___), \nceftriaxone (___), vanco (___), clindamycin \n(___), gentamicin ___ with HD) for post-op \ninfection, meningitis, and sepsis. Patient was found to have \nacinotobacter, klebsiella, and pseudomonas growth on admission \nBAL. His hospitalization antibiotic course is as follows:\nVancomycin ___ ), cefepime (___), gancyclovir Post \nHD (___). Meropenem (___), Cipro for meropenem \nresistant psuedomonas ___ - ___\n\nOn HD31 the patient was transferred out of the ICU to the \nsurgical floor, where he remained stable throughout the \nremainder of his hospitalization. Renal continued to follow and \nthe patient received intermittent hemodialysis. By HD46, the \npatient\'s urine output was appropriate, electrolytes acceptable, \ncreatinine improving, and BUN was stable, so HD was stopped. \nNeurology continued to follow the patient and a repeat brain MRI \non ___ showed no acute intracranial abnormality and progressive \nsupratentorial white matter lesions. Neurology felt it was \nunlikely he would make significant improvements with time. Per \nOrtho Spine, a repeat CT was obtained to evaluate the C1 and C6 \nfractures. The fractures still appeared unstable, therefore \nOrtho Spine recommended keeping the hard cervical collar and \ncommented that surgery was unlikely to be considered helpful \ngiven the limited benefit and considerable risk. On ___, \nthe patient went to Interventional Radiology to have his gastric \ntube switched over to a jejunal feeding tube. His tube feeds \nwere resumed which he was tolerating well. Coumadin was stopped \non ___ after the course was complete for treatment of DVT. The \npatient was only given subcutaneous heparin for DVT prophylaxis. \nThe patient\'s family was applying for ___ and the patient \nwas stable while awaiting for ___ to go through.\n\nAt the time of discharge, the patient was medically stable, \nafebrile with stable vital signs. The patient was tolerating \ntube feeds, out of bed with max-assist and total care with his \nADL\'s, voiding without assistance via condom catheter, and was \nintermittently agitated / in mitt restraints. He was requiring \nintermittent suctioning for moderate secretions. The patient \nwas discharged to rehab. The patient and family received \ndischarge teaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan. He had \nfollow-up scheduled with Spine and Neurology.', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H', '2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing', '3. Artificial Tears Preserv. Free ___ DROP BOTH EYES PRN dry \neyes', '4. Calcium Acetate 1334 mg PO TID W/MEALS', '5. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID', '6. Docusate Sodium (Liquid) 100 mg PO BID', '7. Heparin 5000 UNIT SC BID', '8. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY', '9. LeVETiracetam Oral Solution 500 mg PO BID', '10. Metoprolol Tartrate 12.5 mg PO Q6H', '11. Scopolamine Patch 1 PTCH TD ONCE Duration: 72 Hours', '12. Senna 8.6 mg PO BID:PRN constipation', '13. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line \nflush', '14. TraMADOL (Ultram) 25 mg PO Q8H', '15. TraZODone 50 mg PO 20:00']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'F', 'symptoms': 'bright red blood per rectum', 'medical_history': ['Pancolonic diverticulosis', 'History of presumed diverticular GIBs', 'Hypertension', "Graves' Disease- Previously treated with Methimazole (DC'd \n___, currently Euthyroid", 'Chronic Low back pain', 'OSA (Has CPAP but does not use)'], 'family_history': 'Mother HTN, CVA and DM. Father HTN.', 'present_illness': '___ with known pancolonic diverticulosis and h/o diverticular \nbleed ___ years ago who presents with hematochezia, similar to \nprior diverticulosis bleeding episode. She has had two episodes \nof BRBPR - the first at 6:30PM last night (patiet felt as if she \nhad to pee, had 3 episodes of BRBPR in a couple of minutes with \nassociated cramping) and the second at 1:30AM this morning (dark \nbleeding and clots, about 1 cup++ in volume). At 5:30 AM she \nurinated without passing BRBPR. She says there was nothing to \nwarn her of this bleeding other than some mild lower abdominal \ndiscomfort yesterday afternoon, as if she ate something that did \nnot agree with her. She noted no pain in her lower abdomen or \nepigatrium prior to or during stooling. She says these bleeding \nepisiodes have no stool mixed in, it is frankly bloody. Her last \nBM was yesterday morning and was normal in color and consistency \nwithout evidence of melena or frank blood mixed in. Normally \nshe has a BM 1x/day, though notes in the last year she has had \nmultiple movements back to back in a few minutes span. These \nare soft to occasional diarrhea in consistency, she notes no \nblood in her stool, melena or pencil thin stools at baseline. \nAs for diet - she eats occasional high fiber cereal and greens, \nbut otherwise has a low fiber diet. She enjoys nuts, and is a \nborderline diabetic. She reports one episode of GERD 2 days ago \nbut no active symptoms. She denies current epigastric pain, GERD \nsymptoms, nausea, vomiting, hematemsis, hemotysis. She denies \nlightheadedness, syncope or pre-syncope, no chest pain, \nshortness of breath or palpatations. She does not take \nanticoagulants. \n\nHer last episode of diverticular bleeding was ___ years ago. She \nhad a colonoscopy a few days prior to the onset of bleeding. A \nrepeat colonosopy done after the bleeding started showed no \nsource. She had a stomach ulcer ___ years ago which her doctor \ntold her was ___ stress. She generic tylenol ___ ___ \nfor headaches and chronic right knee/hip pain, but does not use \nASA/naproxen etc.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Cepacol (Sore Throat Lozenge)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & 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'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '296', 'valuenum': 296.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.00', 'valuenum': 5.0, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.4', 'valuenum': 46.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 200.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 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'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LG*.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.040', 'valuenum': 1.04, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '53', 'valuenum': 53.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.3', 'valuenum': 43.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '278', 'valuenum': 278.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.2', 'valuenum': 46.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 187.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 189.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 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'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SM*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LG*.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.025', 'valuenum': 1.025, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hazy*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 173.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '258', 'valuenum': 258.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.9', 'valuenum': 47.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '271', 'valuenum': 271.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.3', 'valuenum': 48.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '276', 'valuenum': 276.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.6', 'valuenum': 48.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 198.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 191.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '257', 'valuenum': 257.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.40', 'valuenum': 4.4, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '48.1', 'valuenum': 48.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '254', 'valuenum': 254.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.5', 'valuenum': 48.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.4', 'valuenum': 46.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.89', 'valuenum': 4.89, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '48.9', 'valuenum': 48.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 173.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '252', 'valuenum': 252.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '285', 'valuenum': 285.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.48', 'valuenum': 4.48, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.2', 'valuenum': 50.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '265', 'valuenum': 265.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAMINATION: \nVITALS: 97.3 160/96 16 86 96%RA \nGENERAL: Obese, well appearing ___ F in NAD \nHEENT: PERRL, EOMI, NCAT, OP WNL \nNECK: no carotid bruits, JVP low \nLUNGS: Reduced breath sounds but CTAB, moving air well and \nsymmetrically \nHEART: RRR, S1 S2 clear and of good quality, no MRG appreciated \n\nABDOMEN: Soft, NT, non-distended, NABS throughout, no HSM \nappreciated \nEXTREMITIES: Trace ___ \nNEUROLOGIC: A+OX3, CN ___ grossly intact \n\nDISCHARGE PHYSICAL EXAMINATION:\nVITALS: 98.4, 97.7, 137/85, 66, 18, 100% on RA\nMN: 700IVF/1BM as above\n24H: 360PO+840IV/multiple loose BMs all with old blood (prepping \nfor ___\nGENERAL: Obese, well appearing, NAD \nHEENT: PERRL, EOMI, NCAT, OP WNL, normal conjuctivae \nNECK: no carotid bruits, flat JVP, NLAD, nl thyroid no nodules \nappreciated\nLUNGS: Reduced breath sounds but CTAB\nHEART: RRR, S1 S2 clear and of good quality, no MRG appreciated \n\nABDOMEN: Soft, non-tender, non-distended, NABS, no HSM \nappreciated \nEXTREMITIES: trace ___, 2+ DP and radial pulses\nNEUROLOGIC: A+OX3, CN ___ grossly intact, senstaion to light \ntouch grossly intact in extremities x4, strength ___ throughout', 'diagnoses': [{'icd_code': 'K430', 'desc': 'Incisional hernia with obstruction, without gangrene'}, {'icd_code': 'C8580', 'desc': 'Other specified types of non-Hodgkin lymphoma, unspecified site'}, {'icd_code': 'Z9484', 'desc': 'Stem cells transplant status'}, {'icd_code': 'Z85038', 'desc': 'Personal history of other malignant neoplasm of large intestine'}, {'icd_code': 'Z9049', 'desc': 'Acquired absence of other specified parts of digestive tract'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'E860', 'desc': 'Dehydration'}], 'summary': "ADMISSION LABS:\n___ 02:40AM BLOOD WBC-5.0 RBC-4.56 Hgb-13.1 Hct-40.1 MCV-88 \nMCH-28.8 MCHC-32.7 RDW-14.0 Plt ___\n___ 02:40AM BLOOD Neuts-41.4* Lymphs-51.2* Monos-3.6 \nEos-2.9 Baso-0.9\n___ 02:40AM BLOOD Glucose-122* UreaN-21* Creat-0.9 Na-143 \nK-3.4 Cl-106 HCO3-26 AnGap-14\n\nHCT TRENDING:\n___ 07:00AM BLOOD Hct-40.4\n___ 12:50PM BLOOD Hct-38.1\n___ 05:25PM BLOOD Hct-37.0\n___ 06:30AM BLOOD Hct-38.0\n___ 05:35PM BLOOD Hct-36.9\n\nDISCHARGE LABS:\n___ 06:15AM BLOOD WBC-4.7 RBC-4.16* Hgb-12.1 Hct-37.1 \nMCV-89 MCH-29.0 MCHC-32.5 RDW-13.6 Plt ___\n___ 06:15AM BLOOD ___ PTT-34.3 ___\n___ 06:15AM BLOOD Glucose-129* UreaN-9 Creat-0.8 Na-142 \nK-3.9 Cl-107 HCO3-27 AnGap-12\n___ 06:15AM BLOOD Calcium-10.1 Phos-2.7 Mg-2.1\n\nCOLONOSCOPY ___:\nOld blood was seen in the colon, from the rectum up to \napproximately the distal ascending colon. There was no evidence \nof active bleeding.\nMultiple diverticula were seen in the distal ascending colon, \ntransverse colon, descending colon and sigmoid colon. \nDiverticulosis appeared to be severe. This the likely cause of \nbleeding, but no definitive source of bleeding was identified.\nPolyps in the descending colon. Polypectomy was not undertaken \nbecause of the hospitalizatoin for GI bleeding.\n\nRecommendations: Repeat colonoscopy within the year as an \noutpatient for polypectomy.\n___ yo F history of previous lower GI bleeds presumed to be \ndiverticular due to pancolonic diverticulosis who presents with \ntwo episodes of hematochezia consistent with bleeding \ndiverticula. \n\nACTIVE ISSUES:\n# GIB: The patient came into the hospital because of two \nepisodes of BRBPR with associated lower abdominal cramping - \nsimilar symptoms to her prior diverticular bleeding episode. She \nwas closely monitored on the floor for a day, during which time \nshe had one bloody bowel movement, and had a Hct drop from 40 to \n38. She prepped for colonoscopy her first night in the \nhospital; colonoscopy the next day showed three polyps and \nsevere pancolonic diverticulosis, but no active bleeding. She \nwas monitored in the hospital for one more day, during which \ntime she had a stable Hct and no further episodes of active \nbleeding. She was maintained on a PPI at a 40mg dose throughout \nher hospitalization. Gastroenterology has scheduled her for a \nrepeat colonoscopy on ___ for polypectomy.\n \nCHRONIC ISSUES:\n# Hypertension: Chronic stable issue that is relatively well \ncontrolled as an outpatient. She was continued on Amlodipine, \nbut her HCTZ was held in the setting of decreased PO intake and \na threatened GI bleed. She was restarted on this medication the \nmorning of discharge.\n \n# OSA: Chronic OSA, has CPAP machine at home though is not \nusing. Recommend outpatient follow up, and TTE at the discretion \nof her primary care physician. \n \n# Grave's Disease: Chronic, stable issue. Patient is currently \neuthyroid after course of Methimazole which was discontinued \n___. \n \n# H/O Parotitis: Chronic, resolved, followed by ENT as an \noutpatient.\n\nTRANSITIONAL ISSUES:\n#Patient requires a repeat colonoscopy within ___ year for \npolypectomy.\n#Patient requires outpatient follow up of her OSA and graves \ndisease."}}
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{'final_diagnoses': ['diverticulosis', 'HTN'], 'procedures': ['Colonoscopy'], 'visit_summary': "___ yo F history of previous lower GI bleeds presumed to be \ndiverticular due to pancolonic diverticulosis who presents with \ntwo episodes of hematochezia consistent with bleeding \ndiverticula. \n\nACTIVE ISSUES:\n# GIB: The patient came into the hospital because of two \nepisodes of BRBPR with associated lower abdominal cramping - \nsimilar symptoms to her prior diverticular bleeding episode. She \nwas closely monitored on the floor for a day, during which time \nshe had one bloody bowel movement, and had a Hct drop from 40 to \n38. She prepped for colonoscopy her first night in the \nhospital; colonoscopy the next day showed three polyps and \nsevere pancolonic diverticulosis, but no active bleeding. She \nwas monitored in the hospital for one more day, during which \ntime she had a stable Hct and no further episodes of active \nbleeding. She was maintained on a PPI at a 40mg dose throughout \nher hospitalization. Gastroenterology has scheduled her for a \nrepeat colonoscopy on ___ for polypectomy.\n \nCHRONIC ISSUES:\n# Hypertension: Chronic stable issue that is relatively well \ncontrolled as an outpatient. She was continued on Amlodipine, \nbut her HCTZ was held in the setting of decreased PO intake and \na threatened GI bleed. She was restarted on this medication the \nmorning of discharge.\n \n# OSA: Chronic OSA, has CPAP machine at home though is not \nusing. Recommend outpatient follow up, and TTE at the discretion \nof her primary care physician. \n \n# Grave's Disease: Chronic, stable issue. Patient is currently \neuthyroid after course of Methimazole which was discontinued \n___. \n \n# H/O Parotitis: Chronic, resolved, followed by ENT as an \noutpatient.\n\nTRANSITIONAL ISSUES:\n#Patient requires a repeat colonoscopy within ___ year for \npolypectomy.\n#Patient requires outpatient follow up of her OSA and graves \ndisease.", 'medications_prescribed': ['Amlodipine 5 mg PO DAILY', 'Hydrochlorothiazide 25 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Potassium Chloride 20 mEq PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 26, 'gender': 'M', 'symptoms': 'weakness', 'medical_history': ['-Neuromyelitis optica', '-Mitral valve prolapse', '-Hypertension', '-Asthma', '-Osteoarthritis, had required steroid injections to the spine \n(well controlled recently)', '-PMR (had been on plaquenil)', '-Depression', '-___ esophagitis', '-Fungal gastritis', '-Anemia', '-Leukopenia (drug induced)', '-Chronic diarrhea/?pancreatic insufficiency on creon', '-Adrenal insufficiency', '-granulomatous lung nodules', '-renal cell carcinoma, left partial nephrectomy'], 'family_history': 'Her father died of lung cancer. Her grandmother died of colon \ncancer. Her older brother had a stroke.', 'present_illness': 'The pt is a ___ right-handed woman with a history of\nneuromyelitis optica diagnosed in ___ (followed by Dr. ___\nwho presents with worsening lower extremity weakness after\nmissing her dose of IVIG last week. She last received 55g IVIG\n___ and ___, and was scheduled for her next monthly\ninfusion on ___. However the weather was bad that day and she\nwas unable to make it in. She was rescheduled for this ___\nand thought she could make it until then, but over the weekend\nshe began to develop worsening lower extremity weakness. She\nreports that when she awoke on ___ morning her legs felt\nheavy and tight, and she had more difficulty than usual\ntransferring into her wheelchair. She is normally able to walk a\nlittle around the house with a walker but has been unable to do\nthis at all for the last few days. She also began to develop\nnumbness and tingling in her legs, which she has had with\nprevious flares. This time however she also reports numbness in\nthe lower part of her torso, which she says she had once in the\npast when she was first diagnosed but she has not experienced\nthis in a long time. She also had difficulty urinating for the\nfirst time on ___ - she has had longstanding issues with\nincomplete emptying and occasional incontinence (straight caths\nherself intermittently at home), but says this was the first \ntime\nshe felt the urge to urinate but was unable to. She denies any\nchanges in bowel function or altered sensation in the perineal\nregion. Her leg weakness continue to progress through the\nweekend, so she called Dr. ___ who advised her to come\ninto the ED.\n\nOn neuro ROS, the pt denies headache, loss of vision, blurred\nvision, diplopia, dysarthria, dysphagia, lightheadedness,\nvertigo, tinnitus or hearing difficulty. Denies difficulties\nproducing or comprehending speech.\n\nOn general review of systems, the pt denies recent fever or\nchills. No night sweats or recent weight loss or gain. Denies\ncough, shortness of breath. Denies chest pain or tightness,\npalpitations. Denies nausea, vomiting, diarrhea, constipation \nor\nabdominal pain. No recent change in bowel or bladder habits. \nNo\ndysuria. Denies arthralgias or myalgias. Denies rash.', 'medications': [{'medication': 'Magnesium Sulfate Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Golytely', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Oncology)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Charcoal Aqueous (Activated)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.3', 'valuenum': 38.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.17', 'valuenum': 4.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: 98.9 60 143/62 18 100% ra\nGeneral: Awake, pleasant and cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx\nNeck: Supple, no nuchal rigidity\nPulmonary: Lungs CTA bilaterally without R/R/W\nCardiac: RRR, nl. S1S2, +systolic murmur\nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or\norganomegaly noted.\nExtremities: No C/C/E bilaterally\nSkin: no rashes or lesions noted.\n\nNeurologic:\n\n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Language is fluent with intact repetition \nand\ncomprehension. Normal prosody. There were no paraphasic errors.\nSpeech was not dysarthric. Able to follow both midline and\nappendicular commands. The pt had good knowledge of current\nevents. There was no evidence of apraxia or neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 4 to 2mm and brisk. VFF to confrontation.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\n-Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally.\nNo adventitious movements, such as tremor, noted. No asterixis\nnoted.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___- 4 5 5- 5- 5 5- 5-\nR 5 ___ ___- 3 5 4 3 5 4 4\n\n-Sensory: Reports decreased sensation to pinprick over RLE from\nmid-shin down. Intact sensation to pinprick over LLE. Sensation\nintact to pinprick over b/l UE. +Sensory level anteriorly at T5\nextending down to groin, where sensation returns. Vibration and\nproprioception are impaired at b/l great toes.\n\n-DTRs:\n Bi Tri ___ Pat Ach\nL 3 3 3 3 3 + clonus\nR 3 3 3 3 3 + clonus\nPlantar response was extensor bilaterally.\n\n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF bilaterally.\n\n-Gait: Deferred\nDISCHARGE EXAMINATION:\nAF VSS\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___- 4- 5 5- 4 5 5- 5-\nR 4+ 4+ ___ ___ 5 4 4- 5 4 4\nPt with some R upper extremity weakness, mostly in C5 \ndistribution. RLE weakness slightly improved, LLE weakness \nunchanged from admission. Patient feels at baseline.', 'diagnoses': [{'icd_code': '938', 'desc': 'Foreign body in digestive system, unspecified'}, {'icd_code': 'E915', 'desc': 'Foreign body accidentally entering other orifice'}, {'icd_code': '30560', 'desc': 'Cocaine abuse, unspecified'}, {'icd_code': '27651', 'desc': 'Dehydration'}], 'summary': 'ADMISSION LABS:\n___ 08:15PM BLOOD WBC-5.2 RBC-3.81* Hgb-11.0* Hct-34.7* \nMCV-91 MCH-28.9 MCHC-31.8 RDW-14.4 Plt ___\n___ 08:15PM BLOOD Neuts-36.2* Lymphs-53.2* Monos-8.2 \nEos-1.9 Baso-0.5\n___ 08:15PM BLOOD Glucose-114* UreaN-26* Creat-0.8 Na-142 \nK-3.9 Cl-105 HCO3-26 AnGap-15\n___ 07:50AM BLOOD Calcium-9.2 Phos-4.1 Mg-1.8\n\nURINARLYSIS:\n___ 08:15PM URINE Color-Yellow Appear-Clear Sp ___\n___ 08:15PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-2* pH-6.5 Leuks-TR\n___ 08:15PM URINE RBC-3* WBC-6* Bacteri-FEW Yeast-NONE \nEpi-1\n\nMICROBIOLOGY:\n URINE CULTURE (Preliminary): \n ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML..\n PRESUMPTIVE IDENTIFICATION. OF TWO COLONIAL \nMORPHOLOGIES.\n Cefazolin interpretative criteria are based on a dosage \nregimen of\n 2g every 8h.\n GRAM NEGATIVE ROD #2. <10,000 organisms/ml.\n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n ESCHERICHIA COLI\n | \nAMPICILLIN------------ =>32 R\nAMPICILLIN/SULBACTAM-- =>32 R\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN--------- =>4 R\nGENTAMICIN------------ =>16 R\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nPIPERACILLIN/TAZO----- 16 S\nTOBRAMYCIN------------ 4 S\nTRIMETHOPRIM/SULFA---- =>16 R\n___ yo RH woman with PMH of NMO diagnosed in ___ (followed by \nDr. ___ who presents with difficulty transferring and sense \nof worsening BLE weakness and tingling/numbness after missing \nher monthly IVIg. It was thought to be due to her missing dose \nof IVIg and after discussion with her outpatient neurologist, \nDr. ___ was made to increase her IVIg to 70 gram/day \nx2 days as her previous dose was thought to be not lasting long \nenough between treatments. Patient received her IVIg in the \nhospital without events. As patient felt improved and back at \nbaseline, she was discharged home.\n\nAs her urinalysis was borderline positive, she was treated with \nantibiotics (ceftriaxone) but it grew out e coli (___) that \nwas similar to her past urine culture, raising question of \ncolonization.'}}
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{'final_diagnoses': ['neuromyelitis optica', 'urinary tract infection', 'hypertension'], 'procedures': ['None'], 'visit_summary': '___ yo RH woman with PMH of NMO diagnosed in ___ (followed by \nDr. ___ who presents with difficulty transferring and sense \nof worsening BLE weakness and tingling/numbness after missing \nher monthly IVIg. It was thought to be due to her missing dose \nof IVIg and after discussion with her outpatient neurologist, \nDr. ___ was made to increase her IVIg to 70 gram/day \nx2 days as her previous dose was thought to be not lasting long \nenough between treatments. Patient received her IVIg in the \nhospital without events. As patient felt improved and back at \nbaseline, she was discharged home.\n\nAs her urinalysis was borderline positive, she was treated with \nantibiotics (ceftriaxone) but it grew out e coli (___) that \nwas similar to her past urine culture, raising question of \ncolonization.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H:PRN pain', 'Baclofen 15 mg PO TID', 'Creon 12 1 CAP PO TID W/MEALS', 'Paroxetine 20 mg PO DAILY', 'Ranitidine 150 mg PO BID', 'Senna 1 TAB PO DAILY:PRN constipation', 'Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600 \nmg(1,500mg) -400 unit Oral daily', 'Ascorbic Acid ___ mg PO TID', 'FiberCon *NF* (calcium polycarbophil) 625 mg Oral QHS prn \nconstipation', 'Poly-Iron *NF* (polysaccharide iron complex) 150 mg iron \nOral BID', 'Zolpidem Tartrate 5 mg PO HS:PRN insomnia', 'Hydrochlorothiazide 25 mg PO DAILY', 'Topiramate (Topamax) 25 mg PO DAILY', 'Potassium Chloride 10 mEq PO BID', 'Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H Duration: 1 \nDays \nStart ___ \nRX *nitrofurantoin monohyd/m-cryst [Macrobid] 100 mg 1 \ncapsule(s) by mouth twice a day Disp #*2 Capsule Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 38, 'gender': 'M', 'symptoms': 'Hepatic Encephalopathy', 'medical_history': ['- Aortic stenosis s/p TAVR ___', '- ___ cirrhosis c/b splenomegaly/thrombocytopenia. No hx of \nvariceal bleeding or ascites requiring paracentesis ', '- HFpEF, also with PH, moderate to severe MR by echo. RHC ___ \n with RAP 10, mPAP 27, PCWP 17 (plus large V waves), high output \n(CI 3.8), PVR 1.5 ___. ', '- Asthma: Diagnosed as an adult. Denies recent prednisone ', '- DM, HTN ', '- Morbid obesity ', '- Episode of syncope, s/p LINQ implantation ___ ', '- Thrombocytopenia, in setting of cirrhosis/splenomegaly ', '- Psoriasis ', '- s/p CCY ', '- s/p C-section x2 ', '- Carpal tunnel ', '- Anxiety ', '- s/p IUD placement ___, for postmenopausal bleeding'], 'family_history': 'Father with MI and died at the age of ___. Mother with unclear \nheart disease and diabetes.', 'present_illness': '___ h/o HCC and ___ cirrhosis, and HTN presents with confusion \nand lethargy. She was discharged 2 days prior to this \npresentation after initial presenting with hepatic \nencephalopathy, ataxia, and weakness. She has a distory of \nmoderately decompensated cirrhosis due to NASH, CKD stage 4, \nsevere pancytopenia and is outpatient transfusion dependent \n(most recent transfusion ___. In addition she is s/p TAVR \nfor severe aortic stenosis with chronic systolic CHF, however \ndue to her severe thrombocytopenia cardiology has been forced to \nback off of all anticoagulation including aspirin.\n\nOn her prior admission she was given aggressive lactulose and \nwith that cleared successfully. She was discharged home with \nservices and per her son became very lethargic the day of \npresentation and had one episode of emesis. Per the ___ and ___ \nher HCP (son ___ believes the patient had 3 doses of \nlactulose, but was so weak walking down the hall that he had to \ncatch her prior to her falling and carried her to the bed, and \nhad to lift her into the bed. On the prior hospitalization she \nwas on q2H lactulose. \n\nShe was previously on hospice but had requested to reverse this \nto full code and cancel her MOLST. Although unclear how clear \nshe was when this was requested. In speaking with both her son \nand Dr. ___ cardiologist she often becomes massively fluid \noverloaded after rehab stays as they seem to solely concentrate \non her encephalopathy therapy ignoring her CHF.', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '-Vitals: reviewed\n-General: NAD, sitting up comfortably in chair \n-HEENT: atraumatic, normocephalic, moist mucus membranes, PERRL, \nEOMi\n-Cardiovascular: systolic murmur, RRR \n-Pulmonary: clear b/l, no wheeze \n-GI: Soft, nontender, distended/ascites, bowel sounds present\n-GU: no foley, no CVA/suprapubic tenderness \n-MSK: trace pedal edema, no joint swelling \n-Skin: No rashes, ulcerations, or jaundice\n-Neuro: no flapping asterixis, alert and interactive, no focal \nneurological deficits, CN ___ grossly intact \n-Psychiatric: appropriate mood and affect', 'diagnoses': [{'icd_code': '5409', 'desc': 'Acute appendicitis without mention of peritonitis'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '79551', 'desc': 'Nonspecific reaction to tuberculin skin test without active tuberculosis'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '7242', 'desc': 'Lumbago'}], 'summary': 'ADMISSION LABS\n___ 12:45AM BLOOD WBC-3.0* RBC-2.43* Hgb-7.9* Hct-23.1* \nMCV-95 MCH-32.5* MCHC-34.2 RDW-15.3 RDWSD-52.7* Plt Ct-16*\n___ 12:45AM BLOOD Neuts-83.8* Lymphs-9.5* Monos-5.7 \nEos-0.7* Baso-0.0 Im ___ AbsNeut-2.48 AbsLymp-0.28* \nAbsMono-0.17* AbsEos-0.02* AbsBaso-0.00*\n___ 12:45AM BLOOD ___ PTT-27.7 ___\n___ 12:45AM BLOOD Glucose-278* UreaN-89* Creat-2.3* Na-138 \nK-5.0 Cl-100 HCO3-23 AnGap-15\n___ 12:45AM BLOOD ALT-14 AST-29 CK(CPK)-78 AlkPhos-104 \nTotBili-1.2\n___ 12:45AM BLOOD Lipase-97*\n___ 12:45AM BLOOD cTropnT-0.03*\n___ 12:45AM BLOOD CK-MB-4\n___ 12:45AM BLOOD Albumin-3.1* Calcium-8.6 Phos-3.6 Mg-2.0\n___ 12:53AM BLOOD ___ pO2-57* pCO2-40 pH-7.39 \ncalTCO2-25 Base XS-0 Comment-GREEN TOP\n\nDISCHARGE LABS\n___ 06:15AM BLOOD WBC-3.1* RBC-2.48* Hgb-8.1* Hct-23.6* \nMCV-95 MCH-32.7* MCHC-34.3 RDW-15.9* RDWSD-54.4* Plt Ct-22*\n___ 09:10AM BLOOD ___\n___ 06:15AM BLOOD Glucose-151* UreaN-76* Creat-2.5* Na-143 \nK-4.3 Cl-105 HCO3-24 AnGap-14\n___ 06:15AM BLOOD ALT-14 AST-31 AlkPhos-97 TotBili-1.1\n\nCXR ___: No acute cardiopulmonary abnormality. Stable \ncardiomegaly. \n\nFlexible sigmoidoscopy: ___ that showed rectal varices but no \nobvious bleeding.\n___ h/o NASH cirrhosis (complicated by esophageal varices, HCC, \nhepatic encephalopathy), severe AS s/p TAVR ___, chronic \ndiastolic heart failure, DM II, CAD, CKD 4, and pancytopenia \npresents with lethargy and nausea/vomiting.\n\n1. Acute on chronic hepatic encephalopathy h/o NASH cirrhosis \nand HCC w/ pancytopenia, elevated INR, ascites\n-Recently admitted ___ with hepatic encephalopathy \nconcerning for lactulose noncompliance vs underdosing. She is \nextremely sensitive to lactulose with resolution of \nencephalopathy with Q2 hour lactulose but redevelopment of \nconfusion/somnolence at TID lactulose. Given difficulty of Q2 \nhours at home she was trialed on 60mL TID w/ meals at the \nsuggestion of her son, which she did very well with during the \nadmission. Going forward patient will need to titrate lactulose \nat home to maintain at least 4 bowel movements per day and clear \nmental status. Given abdominal pain and encephalopathy patient \nmay have SBP, which could have worsened encephalopathy. \nParacentesis not done on admission, and she was empirically \nstarted on ceftriaxone and continued on ciprofloxacin to \ncomplete ___efer to outpatient hepatology whether \nshe should remain on SBP prophylaxis. She was continued on \ntorsemide + spironolactone and rifaximin. Hematology saw \npatient during admission and will follow up with Dr. ___ \n___. As per chart she was considered for TACE or \ntreatment of HCC, which was held due to previously on hospice. \n\n2. GI Bleed h/o esophageal & rectal varices and pancytopenia \n-Visible blood in stool mixed bright and dark blood w/ h/o \nesophageal & rectal varies started on IV PPI, octreotide, and \nSBP prophylaxis with ceftriaxone. She also has a history of \npancytopenia requiring frequent blood transfusions. In setting \nof active bleeding with thrombocytopenia and INR 1.5 she \nreceived 1unit of platelets ___ with goal of >20, vitamin K \n10mg IV ___, and 1Unit PRBC ___. Appreciate hepatology \nrecommendations who performed flex sig ___ that showed rectal \nvarices but no obvious bleeding.\n\nCHRONIC MEDICAL PROBLEMS\n1. Chronic diastolic heart failure: continue torsemide and \nspironolactone\n2. DM II: continue glargine (home 30Units QAM and 17QHS) and \nSSI.\n3. Insomnia: continue trazodone\n4. CKD 4: continue sevelamer \n\n>30 minutes spent on discharge planning '}}
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{'final_diagnoses': ['Hepatic encephalopathy h/o HCC and NASH cirrhosis', 'Lower GI bleed with acute on chronic anemia', 'Possible SBP', 'CKD'], 'procedures': ['Flexible Sigmoidoscopy ___: +for rectal varices', '1Unit platelets ___ PRBC ___'], 'visit_summary': '___ h/o NASH cirrhosis (complicated by esophageal varices, HCC, \nhepatic encephalopathy), severe AS s/p TAVR ___, chronic \ndiastolic heart failure, DM II, CAD, CKD 4, and pancytopenia \npresents with lethargy and nausea/vomiting.\n\n1. Acute on chronic hepatic encephalopathy h/o NASH cirrhosis \nand HCC w/ pancytopenia, elevated INR, ascites\n-Recently admitted ___ with hepatic encephalopathy \nconcerning for lactulose noncompliance vs underdosing. She is \nextremely sensitive to lactulose with resolution of \nencephalopathy with Q2 hour lactulose but redevelopment of \nconfusion/somnolence at TID lactulose. Given difficulty of Q2 \nhours at home she was trialed on 60mL TID w/ meals at the \nsuggestion of her son, which she did very well with during the \nadmission. Going forward patient will need to titrate lactulose \nat home to maintain at least 4 bowel movements per day and clear \nmental status. Given abdominal pain and encephalopathy patient \nmay have SBP, which could have worsened encephalopathy. \nParacentesis not done on admission, and she was empirically \nstarted on ceftriaxone and continued on ciprofloxacin to \ncomplete ___efer to outpatient hepatology whether \nshe should remain on SBP prophylaxis. She was continued on \ntorsemide + spironolactone and rifaximin. Hematology saw \npatient during admission and will follow up with Dr. ___ \n___. As per chart she was considered for TACE or \ntreatment of HCC, which was held due to previously on hospice. \n\n2. GI Bleed h/o esophageal & rectal varices and pancytopenia \n-Visible blood in stool mixed bright and dark blood w/ h/o \nesophageal & rectal varies started on IV PPI, octreotide, and \nSBP prophylaxis with ceftriaxone. She also has a history of \npancytopenia requiring frequent blood transfusions. In setting \nof active bleeding with thrombocytopenia and INR 1.5 she \nreceived 1unit of platelets ___ with goal of >20, vitamin K \n10mg IV ___, and 1Unit PRBC ___. Appreciate hepatology \nrecommendations who performed flex sig ___ that showed rectal \nvarices but no obvious bleeding.\n\nCHRONIC MEDICAL PROBLEMS\n1. Chronic diastolic heart failure: continue torsemide and \nspironolactone\n2. DM II: continue glargine (home 30Units QAM and 17QHS) and \nSSI.\n3. Insomnia: continue trazodone\n4. CKD 4: continue sevelamer \n\n>30 minutes spent on discharge planning ', 'medications_prescribed': ['1. Ciprofloxacin HCl 500 mg PO Q12H \ntake ___ \nRX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day \nDisp #*6 Tablet Refills:*0 ', '2. Glargine 30 Units Breakfast\nGlargine 17 Units Bedtime ', '3. Lactulose 60 mL PO TID W/MEALS ', '4. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB ', '5. Atorvastatin 10 mg PO QPM ', '6. Calcipotriene 0.005% Cream 1 Appl TP BID ', '7. Loratadine 10 mg PO DAILY ', '8. Pantoprazole 40 mg PO Q24H ', '9. Rifaximin 550 mg PO BID ', '10. sevelamer CARBONATE 800 mg PO TID W/MEALS ', '11. Spironolactone 200 mg PO DAILY ', '12. Torsemide 100 mg PO DAILY ', '13. TraZODone 100 mg PO QHS:PRN insomnia ', '14. Ursodiol 300 mg PO BID ', '15. HELD- LORazepam 0.5 mg PO DAILY:PRN anxiety This medication \nwas held. Do not restart LORazepam until you do not have any \nconfusion or sleepiness. Discuss resuming with your PCP', '16.Outpatient Lab Work\nCBC ___, Anemia (ICD 10 D64.9)\nPCP ___ to follow up: fax ___ ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 37, 'gender': 'M', 'symptoms': 'Abdominal pain', 'medical_history': ['- ADHD', '- asthma', '- anxiety', '- eating disorder', '- moderate protein calorie malnutrition', '- migraine headaches', '- h/o endometriosis', '- h/o nephrolithiasis', '- h/o left ovarian cyst', '- h/o sexual assault'], 'family_history': 'Father with MI in ___. Mother with DM, brain aneurysm, stroke in \n___.', 'present_illness': '___ female with a history anxiety, asthma, eating \ndisorder, endometriosis, presenting with abdominal pain and \nhypotension.\n\nThe patient has had recurrent admissions for severe abdominal \npain to ___ and to ___. She frequently presents \nwith hypotension and lactic acidosis in addition to abdominal \npain. An extensive workup has been unrevealing, including \nabdominal imaging, workup for adrenal insufficiency, ___, \nand carcinoid syndrome.\n\nThe patient reports that several days ago she began feeling a \nsimilar abdominal pain in her left lower abdomen. The pain is \nworse with position changes, does not radiate into the back or \nchest. It is associated with nausea but not vomiting. She has \nnot noticed diarrhea, constipation, black stool, or blood in the \nstool. Of note, she has been taking motrin 800 mg several times \na day to control the pain. The pain is not related to menstrual \ncycle or to food intake. No fevers, chills, recent travel, or \nsick contacts. \n\nShe presented again to ___ on ___ with \nrecurrent abdominal pain and palpitations. Evaluation was \nsignificant for tachycardia to the 140s and lactate of 4.5. She \nreceived 3L IVF and was transferred to ___ for need for an \nICU. In ___ ED initial VS: T 98 HR 90 BP 90/53 RR 20 O2 sat \n97% RA. No further documented tachycardia. Lactate had improved \nto 1.4. No further imaging was obtained.\n \nPatient was given vanc, zoysn, and 1 additional L NS prior to \ntransfer to ICU. \n\nOn arrival to the MICU, patient endorses the history above. She \nreports the abdominal pain is currently ___ in severity, and at \nits worst it is ___.', 'medications': [{'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methocarbamol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Colchicine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tacrolimus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tacrolimus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Tacrolimus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52.3', 'valuenum': 52.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.19', 'valuenum': 5.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2,. Estimated GFR = 68 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.022', 'valuenum': 1.022, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.1, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TARGET 12-HR TROUGH (EARLY POST-TX): 5-20 [24-HR TROUGH 33-50% LOWER]. MEASURED BY ___ AS OF ___.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.06', 'valuenum': 5.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.1, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TARGET 12-HR TROUGH (EARLY POST-TX): 5-20 [24-HR TROUGH 33-50% LOWER]. MEASURED BY ___ AS OF ___.'}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.89', 'valuenum': 4.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.2, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TARGET 12-HR TROUGH (EARLY POST-TX): 5-20 [24-HR TROUGH 33-50% LOWER]. MEASURED BY ___ AS OF ___.'}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.96', 'valuenum': 4.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.6, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TARGET 12-HR TROUGH (EARLY POST-TX): 5-20 [24-HR TROUGH 33-50% LOWER]. MEASURED BY ___ AS OF ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n======================\nGENERAL: Alert, oriented, appears uncomfortable but not in acute \ndistress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: Supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: Soft,non-distended. Tender to palpation primarily in left \nlower quadrant without rebound or guarding. Bowel sounds \npresent. No organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: No rashes or jaundice\nNEURO: CNII-XII intact, moves all extremities spontaneously\n\nDISCHARGE PHYSICAL EXAM\n==========================\n24 HR Data (last updated ___ @ 530)\n Temp: 98.5 (Tm 98.5), BP: 88/50 (85-93/50-55), HR: 76\n(74-90), RR: 18 (___), O2 sat: 98% (96-98), O2 delivery: Ra \n\nFluid Balance (last updated ___ @ 2353) \n Last 8 hours Total cumulative 120ml\n IN: Total 120ml, PO Amt 120ml\n OUT: Total 0ml\n Last 24 hours Total cumulative 720ml\n IN: Total 720ml, PO Amt 720ml\n OUT: Total 0ml, Urine Amt 0ml \n\nGENERAL: lying in bed in NAD\nHEENT: Sclera anicteric, MMM, oropharynx clear\nLUNGS: Clear to auscultation bilaterally, no wheezes, rales,\nrhonchi\nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs,\ngallops\nABD: Soft, non-distended, non tender. No rebound or guarding. \nBowel\nsounds present. No organomegaly\nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or\nedema\nSKIN: No rashes or jaundice\nNEURO: CNII-XII intact, moves all extremities spontaneously', 'diagnoses': [{'icd_code': '4238', 'desc': 'Other specified diseases of pericardium'}, {'icd_code': '28419', 'desc': 'Other pancytopenia'}, {'icd_code': '2680', 'desc': 'Rickets, active'}, {'icd_code': 'V427'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V173'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '31401', 'desc': 'Attention deficit disorder with hyperactivity'}, {'icd_code': '3393', 'desc': 'Drug induced headache, not elsewhere classified'}, {'icd_code': 'E9424', 'desc': 'Coronary vasodilators causing adverse effects in therapeutic use'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': 'V5865', 'desc': 'Long-term (current) use of steroids'}], 'summary': "ADMISSION LABS\n=====================\n___ 12:45AM BLOOD WBC-6.4 RBC-2.79* Hgb-7.5* Hct-24.5* \nMCV-88 MCH-26.9 MCHC-30.6* RDW-15.7* RDWSD-50.2* Plt ___\n___ 12:45AM BLOOD Neuts-58.7 ___ Monos-5.3 Eos-0.3* \nBaso-0.5 Im ___ AbsNeut-3.77 AbsLymp-2.24 AbsMono-0.34 \nAbsEos-0.02* AbsBaso-0.03\n___ 05:17AM BLOOD ___ PTT-26.9 ___\n___ 12:45AM BLOOD Glucose-99 UreaN-7 Creat-0.5 Na-142 K-4.4 \nCl-114* HCO3-21* AnGap-7*\n___ 05:17AM BLOOD ALT-6 AST-13 LD(LDH)-167 AlkPhos-44 \nTotBili-0.3\n___ 12:45AM BLOOD Calcium-7.7* Phos-3.6 Mg-1.7\n___ 05:41AM BLOOD ___ Temp-36.6 pO2-53* pCO2-46* \npH-7.34* calTCO2-26 Base XS--1 Intubat-NOT INTUBA\n___ 12:56AM BLOOD Lactate-1.4\n\n___ 02:20AM URINE Color-Straw Appear-Clear Sp ___\n___ 02:20AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 02:20AM URINE UCG-NEGATIVE\n\nMICROBIOLOGY\n======================\n___ 12:40 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): No growth to date.\n\n___ 2:20 am URINE\n\n URINE CULTURE (Final ___: < 10,000 CFU/mL. \n\nINTERVAL LABS\n========================\n___ 03:08PM BLOOD Lactate-6.4* K-3.5\n\nIMAGING\n=======================\nCXR ___ IMPRESSION: No acute pulmonary disease.\n\nCT ABDOMEN/PELVIS ___ IMPRESSION:\n1. No acute intra-abdominal process.\n2. No evidence of nephrolithiasis.\n3. Small amount of hyperdense material layering dependently \nwithin the stomach\nis often attributed to ingested material. However, small amount \nof\nintraluminal hemorrhage may have a similar appearance and should \nbe correlated\nclinically.\n\nPelvic Ultrasound ___\nIMPRESSION: \n \nNormal pelvic ultrasound.\n\nDISCHARGE LABS:\n===============\n___ 06:00AM BLOOD WBC-3.5* RBC-3.30* Hgb-9.2* Hct-29.3* \nMCV-89 MCH-27.9 MCHC-31.4* RDW-15.7* RDWSD-50.4* Plt ___\n___ 06:00AM BLOOD Glucose-118* UreaN-17 Creat-0.6 Na-139 \nK-4.3 Cl-104 HCO3-26 AnGap-9*\n___ 06:00AM BLOOD Calcium-8.5 Phos-4.2 Mg-1.___ female with a history anxiety, asthma, eating \ndisorder, endometriosis, presenting with recurrent abdominal \npain and hypotension.\nACUTES ISSUES\n========================\n#Lactic acidosis:\n#Hypotension: The patient presented with tachycardia to 140s and \nlactate of 4.5 both of which improved with fluids, and BPs at \ndischarge were at baseline (80s-90s/50s-60s). Patient received \nvanc/zosyn in ED, but had no fever, leukocytosis, tachycardia, \ntachypnea, or AMS to suggest sepsis. Prior imaging during these \nepisodes have not shown infection. Inpatient evaluation at ___ \nwas reassuring against endocrinopathy causing hypotenson, \nincluding adrenal insufficiency. TTE normal in ___. No chest \npain, hypoxia, or RHS on EKG to suggest obstructive etiology of \nhypotension. No clear causes of Type B lactic acidosis (though \npt is on albuterol), and lactate resolved with fluids. Her \nhypotension was likely due to baseline low pressures, poor PO \nintake with possible contribution from med effect (trazodone, \nAtivan, gabapentin are home meds). Serum and urine tox negative. \nAntibiotics were not continued on admission. Blood pressures \nwere trended and remained stable throughout the remainder of her \nadmission. The patient was also with a significant history of \nearly death in two siblings before age ___ and severe seizures in \npatient's son concerning for possible underlying \nmitochondrial/genetic component to her repeated episodes. The \npatient will have close follow up with her PCP and will be \nreferred to a genetic counselor for whole genome sequencing.\n\n#Abdominal pain: Extensive workup negative per chart review and \npatient history. She has a history of endometriosis, though pain \nis not related to menstruation and had a normal pelvic \nultrasound this admission. Some concern for gastritis history \ngiven Motrin intake in setting of poor PO intake, though pain is \nmore LLQ/LUQ. UA normal and pregnancy test negative. LFTs normal \nreassuring against hepatobiliary pathology. No rebound/guarding \nto suggest surgical abdomen. CT abodmen/pelvis showed no acute \nprocess. The likely etiology is mitochondrial/genetic disorder \nleading to hypoperfusion causing transient bowel ischemia/ \nabdominal pain and elevated lactate. Rheumatology consulted and \nless likely vasculitis. Negative porphyria. CRP wnl.Her pain was \ncontrolled with analgesics, and at discharge she will receive \nTylenol, Naproxen, Nortryptilline, and Gabapentin. The patient \nis amenable to managing her pain without opioids. \n\n#Acute on chronic normocytic anemia: Hgb was 7.5 on admission \nfrom ___ baseline. No evidence of acute bleeding with negative \nCT and no hematochezia or melena. Has had history of transfusion \nrequirement during pregnancies previously. Given endometriosis \nalso at risk for iron deficiency anemia especially given very \nlow\nferritin. B12 levels wnl previously. Hb stable X 3 days. She \nreceived IV iron with good effect. PO iron can be considered as \nan outpatient. At discharge, the patient's Hb was 9.2. \n\n#Hyperlactemia\nLikely in setting of dehdyration, poor PO intake and resolved \nwith fluids. Low suspicion for an acute infectious process. \nBaseline BPs in the ___. \n\nCHRONIC ISSUES\n=======================\n#Anxiety: Continued home ativan\n\n#ADHD: Held home Adderall\n\n#Migraines: Continue fiorcet PRN\n\n#Insomnia: continue trazadone PRN"}}
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{'final_diagnoses': ['Abdominal pain', 'Hypotension', 'Acute on chronic normocytic anemia', 'Non-anion gap metabolic acidosis', 'Anxiety', 'ADHD'], 'procedures': ['None'], 'visit_summary': "ACUTES ISSUES\n========================\n#Lactic acidosis:\n#Hypotension: The patient presented with tachycardia to 140s and \nlactate of 4.5 both of which improved with fluids, and BPs at \ndischarge were at baseline (80s-90s/50s-60s). Patient received \nvanc/zosyn in ED, but had no fever, leukocytosis, tachycardia, \ntachypnea, or AMS to suggest sepsis. Prior imaging during these \nepisodes have not shown infection. Inpatient evaluation at ___ \nwas reassuring against endocrinopathy causing hypotenson, \nincluding adrenal insufficiency. TTE normal in ___. No chest \npain, hypoxia, or RHS on EKG to suggest obstructive etiology of \nhypotension. No clear causes of Type B lactic acidosis (though \npt is on albuterol), and lactate resolved with fluids. Her \nhypotension was likely due to baseline low pressures, poor PO \nintake with possible contribution from med effect (trazodone, \nAtivan, gabapentin are home meds). Serum and urine tox negative. \nAntibiotics were not continued on admission. Blood pressures \nwere trended and remained stable throughout the remainder of her \nadmission. The patient was also with a significant history of \nearly death in two siblings before age ___ and severe seizures in \npatient's son concerning for possible underlying \nmitochondrial/genetic component to her repeated episodes. The \npatient will have close follow up with her PCP and will be \nreferred to a genetic counselor for whole genome sequencing.\n\n#Abdominal pain: Extensive workup negative per chart review and \npatient history. She has a history of endometriosis, though pain \nis not related to menstruation and had a normal pelvic \nultrasound this admission. Some concern for gastritis history \ngiven Motrin intake in setting of poor PO intake, though pain is \nmore LLQ/LUQ. UA normal and pregnancy test negative. LFTs normal \nreassuring against hepatobiliary pathology. No rebound/guarding \nto suggest surgical abdomen. CT abodmen/pelvis showed no acute \nprocess. The likely etiology is mitochondrial/genetic disorder \nleading to hypoperfusion causing transient bowel ischemia/ \nabdominal pain and elevated lactate. Rheumatology consulted and \nless likely vasculitis. Negative porphyria. CRP wnl.Her pain was \ncontrolled with analgesics, and at discharge she will receive \nTylenol, Naproxen, Nortryptilline, and Gabapentin. The patient \nis amenable to managing her pain without opioids. \n\n#Acute on chronic normocytic anemia: Hgb was 7.5 on admission \nfrom ___ baseline. No evidence of acute bleeding with negative \nCT and no hematochezia or melena. Has had history of transfusion \nrequirement during pregnancies previously. Given endometriosis \nalso at risk for iron deficiency anemia especially given very \nlow\nferritin. B12 levels wnl previously. Hb stable X 3 days. She \nreceived IV iron with good effect. PO iron can be considered as \nan outpatient. At discharge, the patient's Hb was 9.2. \n\n#Hyperlactemia\nLikely in setting of dehdyration, poor PO intake and resolved \nwith fluids. Low suspicion for an acute infectious process. \nBaseline BPs in the ___. \n\nCHRONIC ISSUES\n=======================\n#Anxiety: Continued home ativan\n\n#ADHD: Held home Adderall\n\n#Migraines: Continue fiorcet PRN\n\n#Insomnia: continue trazadone PRN", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H \nRX *acetaminophen 650 mg 1 tablet(s) by mouth every six (6) \nhours Disp #*120 Tablet Refills:*0 ', 'Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN \nabdominal pain \nRX *alum-mag hydroxide-simeth [Maalox Advanced] 200 mg-200 mg-20 \nmg/5 mL ___ ml by mouth four times a day Refills:*0 ', 'Naproxen 500 mg PO Q8H:PRN Pain - Moderate \n Reason for PRN duplicate override: Alternating agents for \nsimilar severity\nRX *naproxen [Naprosyn] 500 mg 1 tablet(s) by mouth three times \na day Disp #*90 Tablet Refills:*0 ', 'Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0 ', 'Gabapentin 900 mg PO TID \nRX *gabapentin 300 mg 3 capsule(s) by mouth three times a day \nDisp #*90 Capsule Refills:*0 ', 'Nortriptyline 25 mg PO QHS \nRX *nortriptyline 25 mg 1 tablet by mouth at bedtime Disp #*30 \nCapsule Refills:*0 ', 'Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing, dyspnea ', 'Hyoscyamine 0.125 mg PO Q6H ', 'LORazepam 0.5 mg PO BID:PRN anxiety ', 'Ondansetron 4 mg PO Q8H:PRN nausea ', 'TraZODone 50 mg PO QHS:PRN insomnia ', 'HELD- Amphetamine-Dextroamphetamine 30 mg PO BID This \nmedication was held. Do not restart \nAmphetamine-Dextroamphetamine until you see your PCP', 'HELD- butalbital-acetaminophen-caff 50-300-40 mg oral \nQ8H:PRN This medication was held. Do not restart \nbutalbital-acetaminophen-caff until while you are taking \nacetaminophen daily for your abdominal pain']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 34, 'gender': 'F', 'symptoms': 'difficulty breathing', 'medical_history': ['PAST ONCOLOGIC HISTORY PER OMR:\n___ Hodgkin lymphoma with extensive chest LAD\nMOPP and ABV chemotherapy\nXRT to chest by Dr. ___ at ___\n___ Relapsed Hodgkin lymphoma\nInduction chemotherapy \n___ Auto BMT by Dr. ___\n___ Elevated hematocrit, fatigue\n___ Hematuria\n___ Small blood clots in urine\n___ CT chest at ___ showed mediastinal, hilar LAD, left \nrenal\nmass\n___ CT urogram shows a large left renal tumor \n___ MRI abdomen shows left renal tumor \n___\n___ Undergoes laparoscopic left radical nephrectomy\nPathology: clear cell renal cell carcinoma\n___ Initial evaluation by Dr. ___ at ___\n___ C1 HD IL-2\n___ DFCI ___ with ___ Plus Sunitinib or Pazolpanib\nfor RCC\n___ C1D1 DFCI ___ - ___ Admitted with pneumonia\n___ Brain MRI shows right cerebellar lesion and bilat CNVIII\nenhancement\n___ CSF cytology negative\n___ Completed SRS to cerebellar lesion via cyber knife\n___ Started pazopanib\n___ MRI head with stable cerebellar lesion and no other\ndefinite disease\n___ CT chest w/ unequivocal response to treatment with\nsignificant interval improvement in right hilar and mediastinal\nlymphadenopathy, pulmonary ___. Stable vascular collaterals in\nthe anterior mediastinum are likely due to a hemodynamically\nsignificant occlusive lesion of the left subclavian vein.\n___ CT torso with continued involution of metastatic renal\ncell decreasing right carcinoma reflected in hilar and \nsubcarinal\nadenopathy and presence of a solitary, shrinking pulmonary\nnodule. Interval decrease in size of bilateral adrenal lesions.\nSimilar appearance of hypodense liver lesions, likely \nmetastases.\nNew regions of differential enhancement within segment 4A and 2\nof the liver may reflect peripheral portal venous thrombosis but\ndoes not represent metastatic disease.\n___ MRI brain with new areas concerning for subclinical\nmetastasis\n___ CK to left frontal lesion and the right occipital \nlesions\n___ CT torso with stable disease\n___ MRI brain, stable disease\n___ CT torso Mild interval increase in size of bilateral\nadrenal metastases and right renal metastatic deposit in keeping\nwith mild progression of disease. Overall stable appearance of\nthe chest except for minimal increase in the right lower lobe\nparatracheal lymph nodes with unchanged sub carinal and right\ndominant necrotic lymph nodes \n___ MRI brain, Increased size of right cerebellar and right\nposterior frontal lobe. Decreased size of a right occipital lobe\nmetastasis and stable left frontal and left parafalcine\nmetastases.', '- Likely metastatic renal cell carcinoma, as above', '- Hodgkin lymphoma', '- Hypertension'], 'family_history': 'Mother had ___ lymphoma. Maternal grandfather had renal \ncell carcinoma in his ___. Maternal uncle had ___ \nlymphoma. Another maternal uncle had melanoma. Maternal aunt had \nrenal cell carcinoma in her late ___. Paternal uncle had \nprostate cancer and pancreatic cancer. ', 'present_illness': 'Ms. ___ is a pleasant ___ w/ h/o Hodgkin lymphoma s/p auto-BMT\nin ___, metastatic renal cell carcinoma s/p multiple lines of\ntreatment, SRS to R occipital and L frontal lesion in ___ and\n___, leptomeningeal disease (evident by b/l CN VIII enhancement\nbut neg CSF cytology), on pazopanib since ___ complicated by\nsevere diarrhea, presents w/ sever DOE.\n\nShe states her symptoms started early ___. She went to ___\nand noticed that she was more tired than usual. She was having\nintermittent "stomach upset" which she thought was a virus and \nit\nwould go away. She also noted that she was intermittently SOB \nand\nalso attributed it to a viral process.\n\nOver the last week, she has developed progressive DOE w/ minimal\nactivity and fatigued despite eating and drinking well. No chest\npain. No palpitations. No dizziness. No fevers, no chills. No\ncough. She is SOB even putting on clothes. \n\nShe also admits to b/l ___ calf tightness but no ___. She states\nher calves "hurt when I point my toes up." She denied any\nPND/orthopnea. Uses 1 pillow to sleep. She admits to diarrhea\nthat hs been ongoing and stable and unchanged. Moves bowels\n~6x/day.', 'medications': [{'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '285', 'valuenum': 285.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.55', 'valuenum': 4.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'DiSCHARGE EXAM:\nGeneral: NAD, Resting in bed comfortably\nVITAL SIGNS: 97.9 ___ 18 99%RA\nHEENT: MMM, OP clear\nCV: RR, NL S1S2 no S3S4 No MRG\nPULM: CTAB, nonlabored\nABD: BS+, soft, NTND, no palpable masses or HSM\nLIMBS: WWP, no ___, no tremors\nSKIN: No rashes on the extremities\nNEURO: ___, EOMI, face symmetric, no nystagmus, sensation \nintact to light touch, moves all ext against resistance, gait \nnormal', 'diagnoses': [{'icd_code': '64843', 'desc': 'Mental disorders of mother, antepartum condition or complication'}, {'icd_code': '29181', 'desc': 'Alcohol withdrawal'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': 'ADMISSION LABS:\n\n___ 04:50PM BLOOD WBC-7.4# RBC-5.55*# Hgb-16.5*# Hct-48.6* \nMCV-88# MCH-29.7 MCHC-34.0 RDW-13.8 RDWSD-44.1 Plt ___\n___ 04:50PM BLOOD Neuts-65.6 ___ Monos-7.1 Eos-0.4* \nBaso-0.4 Im ___ AbsNeut-4.88# AbsLymp-1.94 AbsMono-0.53 \nAbsEos-0.03* AbsBaso-0.03\n___ 04:50PM BLOOD Glucose-94 UreaN-42* Creat-1.5* Na-134 \nK-4.6 Cl-105 HCO3-11* AnGap-23*\n___ 04:50PM BLOOD Calcium-9.9 Phos-3.0 Mg-2.1\n\nDISCHARGE LABS:\n\n___ 07:18AM BLOOD Glucose-96 UreaN-23* Creat-1.0 Na-138 \nK-4.2 Cl-109* HCO3-20* AnGap-13\n___ 07:18AM BLOOD Calcium-9.1 Phos-2.9 Mg-1.9\n\nEchocardiogram:\nThe left atrium is normal in size. The estimated right atrial \npressure is ___ mmHg. Left ventricular wall thickness, cavity \nsize, and global systolic function are normal (LVEF = 70%). Due \nto suboptimal technical quality, a focal wall motion abnormality \ncannot be fully excluded. Right ventricular chamber size and \nfree wall motion are normal. The diameters of aorta at the \nsinus, ascending and arch levels are normal. The aortic valve \nleaflets (3) appear structurally normal with good leaflet \nexcursion and no aortic stenosis or aortic regurgitation. The \nmitral valve leaflets are mildly thickened. Trivial mitral \nregurgitation is seen. The left ventricular inflow pattern \nsuggests impaired relaxation. The pulmonary artery systolic \npressure could not be determined. The pulmonary artery is not \nwell visualized. There is no pericardial effusion. \n\nCompared with the prior study (images reviewed) of ___, \nthe findings are similar. \n\n___ U/S:\nReportFINDINGS: \n \nPreliminary ReportThere is normal compressibility, flow and \naugmentation of the bilateral common \nPreliminary Reportfemoral, femoral, and popliteal veins. Normal \ncolor flow and compressibility \nPreliminary Reportare demonstrated in the posterior tibial and \nperoneal veins. \n \nPreliminary ReportThere is normal respiratory variation in the \ncommon femoral veins bilaterally. \n \nPreliminary ReportNo evidence of medial popliteal fossa (___) \ncyst. \n \nPreliminary ReportIMPRESSION: \n \nPreliminary ReportNo evidence of deep venous thrombosis in the \nbilateral lower extremity veins \n\nCTA chest:\nIMPRESSION: \n \n1. No evidence of pulmonary embolism or aortic abnormality. \n2. Stable metastatic disease with lytic destruction of right \nposterior lateral seventh rib with a stable minimally displaced \npathologic fracture, bilateral adrenal metastases, and \nparatracheal, subcarinal, and right hilar lymphadenopathy. \n3. Stable hepatic hypodensities as described above. \n4. Stable pulmonary nodules, unchanged since ___.\n___ w/ h/o Hodgkin lymphoma s/p auto-BMT in ___, metastatic \nrenal cell carcinoma s/p multiple lines of treatment, SRS to R \noccipital and L frontal lesion in ___ and ___, leptomeningeal \ndisease (evident by b/l CN VIII enhancement but neg CSF\ncytology), on pazopanib since ___ complicated by severe \ndiarrhea, presents w/ severe DOE and calf tightness. \n\n#DOE - High suspicion for PE given symptoms and underlying \nmalignancy. Initially w/ ___ thus contrast avoided. ___ U/S \nnegative for DVT. CT w/ constrast performed after Cr improved \nand was negative for PE. No other intra-pulmonary cause for \ndyspnea, no infiltrates or edema. Echo obtained showed normal \ncardiac function w/o pericardial effusion.\nIt is unclear what caused her severe dyspnea but she did have \nsignificant metabolic acidosis on admission and may have had \ncompensatory work of breathing from this. Drug effect is also \npossible but CT chest did not show pneumonitis. At time of \ndischarge patient able to ambulate indepedently, no \ndesaturation.\n\n#Acute Kidney Injury\n#High Anion Gap Metabolic Acidosis\nLikely prerenal from diarrhea and in setting of taking \nlisinopril\nImproved w/ stopping ACE-I and hydration\n- pt will start sodium bicarb supplementation as ongoing loose \nstools expected while taking pazopanib\n- Cr normalized and she was given addnl hydration post CT \ncontrast\n\n#Metastatic Renal Cell Carcinoma with Brain ___\n- completed ___ stable since last MRI ___\n- patient will resume pazopanib at lower dose of 600mg as she is \nexperiencing adverse effect of diarrhea and possibly dyspnea\n- CT chest showed stable LAD\n- she will return for follow up w/ Dr ___ in 2 weeks\n\n#HTN\n- holding lisinopril as above, BP low normal at time of \ndischarge '}}
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{'final_diagnoses': ['Severe dyspnea'], 'procedures': ['None'], 'visit_summary': '___ w/ h/o Hodgkin lymphoma s/p auto-BMT in ___, metastatic \nrenal cell carcinoma s/p multiple lines of treatment, SRS to R \noccipital and L frontal lesion in ___ and ___, leptomeningeal \ndisease (evident by b/l CN VIII enhancement but neg CSF\ncytology), on pazopanib since ___ complicated by severe \ndiarrhea, presents w/ severe DOE and calf tightness. \n\n#DOE - High suspicion for PE given symptoms and underlying \nmalignancy. Initially w/ ___ thus contrast avoided. ___ U/S \nnegative for DVT. CT w/ constrast performed after Cr improved \nand was negative for PE. No other intra-pulmonary cause for \ndyspnea, no infiltrates or edema. Echo obtained showed normal \ncardiac function w/o pericardial effusion.\nIt is unclear what caused her severe dyspnea but she did have \nsignificant metabolic acidosis on admission and may have had \ncompensatory work of breathing from this. Drug effect is also \npossible but CT chest did not show pneumonitis. At time of \ndischarge patient able to ambulate indepedently, no \ndesaturation.\n\n#Acute Kidney Injury\n#High Anion Gap Metabolic Acidosis\nLikely prerenal from diarrhea and in setting of taking \nlisinopril\nImproved w/ stopping ACE-I and hydration\n- pt will start sodium bicarb supplementation as ongoing loose \nstools expected while taking pazopanib\n- Cr normalized and she was given addnl hydration post CT \ncontrast\n\n#Metastatic Renal Cell Carcinoma with Brain ___\n- completed ___ stable since last MRI ___\n- patient will resume pazopanib at lower dose of 600mg as she is \nexperiencing adverse effect of diarrhea and possibly dyspnea\n- CT chest showed stable LAD\n- she will return for follow up w/ Dr ___ in 2 weeks\n\n#HTN\n- holding lisinopril as above, BP low normal at time of \ndischarge ', 'medications_prescribed': ['1. Escitalopram Oxalate 10 mg PO DAILY ', '2. Loratadine 10 mg PO DAILY ', '3. Zolpidem Tartrate 5 mg PO HS ', '4. Opium Tincture (morphine 10 mg/mL) 6 mg PO Q3 HR PRN diarrhea \n\nRX *opium tincture 10 mg/mL (morphine) 6 mg by mouth every 3 \nhours as needed Refills:*0', '5. Votrient (PAZOPanib) 600 mg oral DAILY ', '6. Sodium Bicarbonate 650 mg PO BID \nRX *sodium bicarbonate 650 mg 1 tablet(s) by mouth twice a day \nDisp #*120 Tablet Refills:*2']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 37, 'gender': 'M', 'symptoms': 'asymptomatic lung nodules', 'medical_history': ['Silent MI likely ___', 'CAD', 'HTN', 'DM', 'Obesity', 'Pneumonia ___ complicated by sepsis', 'L leg cellulitis', 'L leg tibial plateau fx', 'MGUS'], 'family_history': 'non contributory', 'present_illness': 'Mr. ___ is a ___ year old male, former smoker presenting to \nclinic with his daughter to discuss lung nodules found in his \nLUL on screening CT scan that in\n___ were stable from prior study but were increased in size\non CT scan on ___. The patient also has the images from a\nPET CT scan and PFTs that were completed prior to his visit\ntoday. The patient reports that his general health have been at\nbaseline, but that his baseline health has declined over the \npast\nfew years secondary to heart problems that began a couple of\nyears ago. He is able to walk about a half mile before becoming\nshort of breath, but notes that at least one flight of stairs\nwill cause him to become short of breath. Has baseline edema b/l\nlegs, worse on L after a cellulitis episode ___ years ago. No\ndyspnea at rest, fevers, malaise, night sweats, chills,\nunintentional weight loss, chest pain, palpitations, hemoptysis,\npersistent cough, orthopnea, abdominal pain, bony pain, \nweakness.', 'medications': [{'medication': 'Mesalamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mercaptopurine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '361', 'valuenum': 361.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2,. Estimated GFR = 68 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '329', 'valuenum': 329.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '428', 'valuenum': 428.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Clinic Physical Exam:\nBP: 150/64. Heart Rate: 57. O2 Saturation%: 95. Weight: 246.4.\nHeight: 68. BMI: 37.5. Temperature: 97.3. Resp. Rate: 16. Pain\nScore: 0.\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [x] Thyroid nl size/contour\n[ ] Abnormal findings: \n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal [x] No fremitus\n[x] No egophony [x] No spine/CVAT\n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [ ] No m/r/g [x] No JVD [x] PMI nl [x] No edema\n[x] Peripheral pulses nl [x] No abd/carotid bruit\n[x] Abnormal findings: Brief grade III systolic decrescendo\nmurmur auscultated at RUSB and LUSB.\n\nGI \n[x] Soft [x] NT [x] ND [x] No mass/HSM [x] No hernia\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[x] Abnormal findings: small reducible umbilical hernia\n\nNEURO \n[x] Strength intact/symmetric [x] Sensation intact/ symmetric\n[x] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[x] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n[x] No clubbing [x] No cyanosis [ ] No edema [x] Gait nl\n[x] No tenderness [x] Tone/align/ROM nl [x] Palpation nl\n[x] Nails nl [x] Abnormal findings: \n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl\n[x] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n\nDischarge Physical Exam:\nV/S: T98.0, HR76, BP136/73, RR19, Sat97%RA\nGen: AAOx3, NAD, sitting comfortably in chair\nHEENT: MMM, no scleral icterus\nResp: nl effort, CTABL, mild expiratory wheezing b/l improved \nfrom prior\nIncisions C/D/I with dermabond, chest tube site C/D/I with \ngauze/tegaderm\nCV: RRR, nl S1/S2, no S3/S4, no murmurs/rubs/gallops\nAbd: +BS, soft, NT/ND\nExt: WWP, no edema', 'diagnoses': [{'icd_code': '5559', 'desc': 'Regional enteritis of unspecified site'}, {'icd_code': '56089', 'desc': 'Other specified intestinal obstruction'}, {'icd_code': '56981', 'desc': 'Fistula of intestine, excluding rectum and anus'}, {'icd_code': '5680', 'desc': 'Peritoneal adhesions (postoperative) (postinfection)'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '73390', 'desc': 'Disorder of bone and cartilage, unspecified'}, {'icd_code': '4556', 'desc': 'Unspecified hemorrhoids without mention of complication'}, {'icd_code': '4240', 'desc': 'Mitral valve disorders'}, {'icd_code': '2662', 'desc': 'Other B-complex deficiencies'}, {'icd_code': '30560', 'desc': 'Cocaine abuse, unspecified'}, {'icd_code': '30521', 'desc': 'Cannabis abuse, continuous'}, {'icd_code': 'V5865', 'desc': 'Long-term (current) use of steroids'}], 'summary': " WBC RBC Hgb Hct MCV MCH MCHC RDW \nRDWSD Plt Ct \n___ 05:45 7.4 3.39* 10.0* 32.2* 95 29.5 31.1* 13.2 \n45.4 227 \n___ 05:35 8.7 3.33* 9.6* 31.1* 93 28.8 30.9* 13.3 \n45.7 184 \n___ 06:10 11.9* 3.41* 10.1* 32.1* 94 29.6 31.5* 13.8 \n47.3* 172 \n___ 05:10 12.4* 3.82* 11.1* 36.2* 95 29.1 30.7* 14.0 \n48.9* 170 \n___ 06:05 10.5* 3.80* 11.1* 34.6* 91 29.2 32.1 13.7 \n45.5 184 \n___ 17:34 11.4* 3.77* 10.9* 34.5* 92 28.9 31.6* 13.1 \n43.7 171\n \n Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 05:45 208*1 46* 1.5* 136 4.0 98 26 16 \n___ 05:50 801 50* 1.4* 139 4.0 99 28 16 \n___ 15:30 135*1 57* 1.6* 139 4.0 98 30 15 \n___ 05:35 121*1 55* 1.7* 138 4.0 98 29 15 \n___ 15:35 304*1 62* 2.0* 130* 4.6 94* 25 16 \n___ 06:10 216*1 63* 2.7* 137 4.5 96 25 21* \n___ 15:30 252*1 58* 2.5* 136 4.7 99 27 15 \n___ 05:10 266*1 51* 2.6* 133 4.8 95* 25 18 \n___ 13:21 239*1 40* 1.8* 138 4.5 ___\n___ 06:05 231*1 37* 1.8* 137 4.6 100 26 16 \n___ 23:52 268*1 35* 1.6* 136 4.7 98 27 16 \n___ 17:34 276*1 42* 1.8* 133 5.7* 99 26 14 \n\n___ 9AM INR 1.0\n\nCXR post-op ___:\n1. The tip of the endotracheal tube projects over the carina, \npointing \ntowards the right mainstem bronchus. Retraction is recommended. \n This finding was communicated to and acknowledged by ___ \n___, MD at 16h38 by ___, MD. \n2. Postsurgical changes in the left lung as described above. \nNo pneumothorax \nidentified. \n3. Interval development of vascular crowding, may be \npostsurgical or \nsecondary to fluid status \n\nCXR post-pull of chest tube ___: \nCompared to chest radiographs ___ through ___ at \n06:11. \nPrevious left thoracostomy tube has been removed. Left apical \npneumothorax is small if any. Unusual configuration of the \nright apex could be explained by is loculated fluid collection \nor unusual left upper lobe collapse. There is no layering \npleural effusion. Moderate to severe cardiomegaly persists, \npulmonary vascular congestion has worsened and mild pulmonary \nedema has developed.\n\nCXR prior to discharge ___:\nIn comparison with the study of ___, the air-fluid level \nhas migrated even further cephalad. Otherwise, little change.\nMr. ___ was admitted to the hospital and taken to the \nOperating Room where he underwent a VATS, left upper lobe wedge \nresection followed by VATS left upper lobe upper division by \nsegmentectomy, left lower lobe superior segmentectomy, \nmediastinal lymph node dissection, bronchoscopy with lavage. He \ntolerated the procedure well and returned to the PACU in stable \ncondition. He maintained stable hemodynamics and his pain was \ncontrolled with IV Tylenol and Dilaudid. His ___ drain put \nout moderate amounts of thin bloody fluid and had no air leak.\n\nFollowing transfer to the Surgical floor he developed ___ on \npost op day #1 with a creatinine of 1.8. His urine output was > \n30c's/hr and his blood pressure was 120-160/70. His pre op \nantihypertensives were held along with his Lasix and he remained \nonly on Metoprolol 12.5 mg BID. His pain was controlled with \nOxycodone and Tylenol but he preferred using only Tylenol in \ngeneral. He was tolerating a regular diabetic diet but his blood \nsugars were poorly controlled. His lantus was gradually \nincreased and his sliding scale was tightened but ultimately the \n___ diabetic service was consulted for daily management. \nOther than Lantu and SSRI, his Metformin was stopped months ago \ndue to his kidney function and he was not on Victoza. His sugars \nwere gradually under 200.\n\nOnce his ___ tube drainage decreased, his drain was removed \nand he was more comfortable. His port sites were healing well \nand his chest xray showed a small left apical space. He was \nencouraged to use his incentive spirometer more often due to \natelectasis. He was using his BIPAP mask at night and weaning \nfrom oxygen during the day.\n\nHis renal function was monitored daily and peaked at 2.7 on \n___ and then slowly decreased to 1.5 at the time of \ndischarge, which is his baseline. His Lasix was resumed to help \nalleviate some of his peripheral edema and soon his oxygen \nrequirements were nil with room air saturations of 95%. \n\nHe developed atrial fibrillation on ___ with rates of \n80-110 and he was asymptomatic. His Metoprolol was gradually \nincreased for rate control and on 37.5 mg BID his rate was in \nthe 80's with a BP of 140/70. His Cardiologist, Dr. ___ was \nnotified of his persistent atrial fibrillation and recommended \nstarting Coumadin and bridging with Lovenox. His INR prior to \nstarting was 1.0 and he received 5 mg on ___ along with \nLovenox ___ mg BID. He was instructed in how to administer \nLovenox but he's familiar with injections due to giving himself \ninsulin. His INR will be followed by the ___ \nat ___. His daughter was also updated on these \nmedication changes/additions.\n\nAfter a longer than expectes stay he was discharged to home on \n___ and will follow up with Dr. ___ Dr. ___ \nin 2 weeks."}}
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{'final_diagnoses': ['Left upper lobe and left lower lobe nodules', '___', 'Urinary retention', 'Atrial fibrillation'], 'procedures': ['VATS, left upper lobe wedge resection followed by\nVATS left upper lobe upper division by segmentectomy, left\nlower lobe superior segmentectomy, mediastinal lymph node\ndissection, bronchoscopy with lavage.'], 'visit_summary': "Mr. ___ was admitted to the hospital and taken to the \nOperating Room where he underwent a VATS, left upper lobe wedge \nresection followed by VATS left upper lobe upper division by \nsegmentectomy, left lower lobe superior segmentectomy, \nmediastinal lymph node dissection, bronchoscopy with lavage. He \ntolerated the procedure well and returned to the PACU in stable \ncondition. He maintained stable hemodynamics and his pain was \ncontrolled with IV Tylenol and Dilaudid. His ___ drain put \nout moderate amounts of thin bloody fluid and had no air leak.\n\nFollowing transfer to the Surgical floor he developed ___ on \npost op day #1 with a creatinine of 1.8. His urine output was > \n30c's/hr and his blood pressure was 120-160/70. His pre op \nantihypertensives were held along with his Lasix and he remained \nonly on Metoprolol 12.5 mg BID. His pain was controlled with \nOxycodone and Tylenol but he preferred using only Tylenol in \ngeneral. He was tolerating a regular diabetic diet but his blood \nsugars were poorly controlled. His lantus was gradually \nincreased and his sliding scale was tightened but ultimately the \n___ diabetic service was consulted for daily management. \nOther than Lantu and SSRI, his Metformin was stopped months ago \ndue to his kidney function and he was not on Victoza. His sugars \nwere gradually under 200.\n\nOnce his ___ tube drainage decreased, his drain was removed \nand he was more comfortable. His port sites were healing well \nand his chest xray showed a small left apical space. He was \nencouraged to use his incentive spirometer more often due to \natelectasis. He was using his BIPAP mask at night and weaning \nfrom oxygen during the day.\n\nHis renal function was monitored daily and peaked at 2.7 on \n___ and then slowly decreased to 1.5 at the time of \ndischarge, which is his baseline. His Lasix was resumed to help \nalleviate some of his peripheral edema and soon his oxygen \nrequirements were nil with room air saturations of 95%. \n\nHe developed atrial fibrillation on ___ with rates of \n80-110 and he was asymptomatic. His Metoprolol was gradually \nincreased for rate control and on 37.5 mg BID his rate was in \nthe 80's with a BP of 140/70. His Cardiologist, Dr. ___ was \nnotified of his persistent atrial fibrillation and recommended \nstarting Coumadin and bridging with Lovenox. His INR prior to \nstarting was 1.0 and he received 5 mg on ___ along with \nLovenox ___ mg BID. He was instructed in how to administer \nLovenox but he's familiar with injections due to giving himself \ninsulin. His INR will be followed by the ___ \nat ___. His daughter was also updated on these \nmedication changes/additions.\n\nAfter a longer than expectes stay he was discharged to home on \n___ and will follow up with Dr. ___ Dr. ___ \nin 2 weeks.", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q6H', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*60 Capsule Refills:*2', 'Enoxaparin Sodium 100 mg SC BID atrial fibrillation \nStart: Today - ___, First Dose: Next Routine Administration \nTime \nRX *enoxaparin 100 mg/mL 100 mg SC twice a day Disp #*14 Syringe \nRefills:*3', 'GuaiFENesin ER 1200 mg PO Q12H \nRX *guaifenesin 1,200 mg 1 tablet(s) by mouth q12hrs Disp #*60 \nTablet Refills:*0', 'Montelukast 10 mg PO DAILY', 'OxyCODONE (Immediate Release) ___ mg PO Q3H:PRN pain \nRX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp \n#*20 Tablet Refills:*0', 'Senna 8.6 mg PO BID:PRN constipation', 'Tamsulosin 0.4 mg PO QHS \nRX *tamsulosin 0.4 mg 1 capsule(s) by mouth at bedtime Disp #*14 \nCapsule Refills:*0', 'Warfarin 2.5 mg PO DAILY16 \ntake the dose prescribed by the ___ clinic \nRX *warfarin 2.5 mg 1 tablet(s) by mouth once a day Disp #*100 \nTablet Refills:*2', 'Furosemide 40 mg PO BID', 'Glargine 46 Units Breakfast\nGlargine 46 Units Dinner', 'Regular 15 Units Dinner', 'Metoprolol Tartrate 37.5 mg PO BID \nRX *metoprolol tartrate 37.5 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*2', 'amLODIPine 10 mg PO DAILY', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 40 mg PO QPM', 'Calcitriol 0.25 mcg PO DAILY', 'Cyanocobalamin 100 mcg PO DAILY', 'Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY', 'omega-3 fatty acids-fish oil 360-1,200 mg oral BID', 'Victoza 3-Pak (liraglutide) 0.6 mg/0.1 mL (18 mg/3 mL) \nsubcutaneous DAILY', 'Vitamin E 400 UNIT PO DAILY', 'HELD- CloNIDine 0.2 mg PO TID This medication was held. Do \nnot restart CloNIDine until seen by Dr. ___']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'M', 'symptoms': 'back pain', 'medical_history': ['chronic pain', 'Asthma', 'COPD', 'Gout', 'arthritis', 'obesity', 'GERD', 'renal insufficiency (Stage III)', 'DM2', 'incontinence', 'h/o liver damage', 'fibromyalgia', 'depression', 'chronic low back pain', 'depression', 'anxiety', 'and cervical radiculopathy'], 'family_history': 'Positive for cancer, diabetes, heart disease,\nand kidney disease.', 'present_illness': 'Ms. ___ returns to the office for evaluation of\nlumbar radiculopathy. She states for the past several months her\nback pain continues to worsen. She describes the pain as a\nstabbing, aching sensation that is ___ on pain scale. It \nbecomes\nunbearable with activity. She has to use a cane to walk. She\ndescribes pain shooting to her posterior buttocks down the the\nheel of her left leg and sometime has pain in her right leg to\nher thigh and front of her foot. She has tried ___, injections,\nand home exercises with no relief of pain. She is getting\ndepressed secondary to pain. She denies weakness or \nparesthesias.', 'medications': [{'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxymetazoline', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nadolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bengay Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.69', 'valuenum': 2.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 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'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.89', 'valuenum': 2.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '259', 'valuenum': 259.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.74', 'valuenum': 2.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '271', 'valuenum': 271.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'General Examination: \n GENERAL APPEARANCE: in no acute distress, well developed,\nwell nourished. \n HEAD: normocephalic, atraumatic. \n SKIN: wound clean, well approximated. \n HEART: no murmurs, regular rate and rhythm, S1, S2 \nnormal.\n\n LUNGS: clear to auscultation bilaterally. \n ABDOMEN: normal, bowel sounds present, soft, nontender,\nnondistended. \n MUSCULOSKELETAL: cervical spine normal, full range of\nmotion, lumbosacral spine normal, no swelling or deformity. \n EXTREMITIES: Gross motor strength is intact in terms of\ndeltoid, biceps, triceps, wrist extension/flexion, finger\nextension/flexion and intrinsics, no clubbing, cyanosis, or\nedema. \n NEUROLOGIC: nonfocal, motor strength normal upper and\nlower extremities, sensory exam intact. \n Mental Status Patient was oriented to time, place, and\nperson. There was a normal fund of knowledge and normal affect..\n\n Myelopathy \n ___ Sign Negative\n Babinski Absent\n Reflexes 2+ biceps, brachioradialis, triceps, 0+\nquadriceps, and achilles reflexes. \n\nPostop\nGen: confusion improved, alert, awake ,cooperative with exam\nskin: incision is c/d/i\nNeuro AOX2, strength full, sensory intact\ncalves are soft/nt\nresp: good effort\nabd: soft, nt/nd', 'diagnoses': [{'icd_code': '99811', 'desc': 'Hemorrhage complicating a procedure'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'V4983', 'desc': 'Awaiting organ transplant status'}, {'icd_code': '45621', 'desc': 'Esophageal varices in diseases classified elsewhere, without mention of bleeding'}, {'icd_code': '28749', 'desc': 'Other secondary thrombocytopenia'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '4731', 'desc': 'Chronic frontal sinusitis'}, {'icd_code': '4718', 'desc': 'Other polyp of sinus'}, {'icd_code': '4733', 'desc': 'Chronic sphenoidal sinusitis'}, {'icd_code': '4730', 'desc': 'Chronic maxillary sinusitis'}, {'icd_code': '7847', 'desc': 'Epistaxis'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': 'V1261', 'desc': 'Personal history of pneumonia (recurrent)'}, {'icd_code': '4940', 'desc': 'Bronchiectasis without acute exacerbation'}, {'icd_code': '0417', 'desc': 'Pseudomonas infection in conditions classified elsewhere and of unspecified site'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '79092', 'desc': 'Abnormal coagulation profile'}, {'icd_code': '78702', 'desc': 'Nausea alone'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V454'}], 'summary': "Gallbladder u/s ___ Echogenic liver consistent with \nsteatosis. Other forms of liver disease \nincluding steatohepatitis, hepatic fibrosis, or cirrhosis cannot \nbe excluded \non the basis of this examination. The gallbladder is not \nvisualized. \n\n___ 06:05PM GLUCOSE-287* UREA N-21* CREAT-1.4* SODIUM-138 \nPOTASSIUM-5.3* CHLORIDE-103 TOTAL CO2-22 ANION GAP-13\n___ 06:05PM estGFR-Using this\n___ 06:05PM CALCIUM-8.4 PHOSPHATE-3.6 MAGNESIUM-1.7\n___ 06:05PM WBC-14.1* RBC-3.55* HGB-10.6*# HCT-30.5* \nMCV-86 MCH-29.9 MCHC-34.8 RDW-12.6 RDWSD-39.2\n___ 06:05PM PLT COUNT-267\nPatient was admitted to Orthopedic Spine Service and underwent \nthe above stated procedure(s). Patient tolerated the procedures \nwell without complication. Please review dictated operative \nreport for details. Patient was extubated without incident and \nwas transferred to PACU then floor in stable condition. \n\n \n\nDuring her course ___ were used for postoperative \nDVT prophylaxis. Intravenous antibiotics were continued for \n24hrs postop per standard protocol. Initial postop pain was \ncontrolled with oral and IV pain medication. Diet was advanced \nas tolerated. Foley was removed in routine fashion and patient \nvoided without incident. Lumbar epidural catheter was removed \non POD#1. Hemovac was removed in routine fashion once the \noutput per 8 hours became minimal. \n\n \n\nPhysical therapy and Occupational therapy were consulted for \nmobilization OOB to ambulate and ADL's. Hospital course was \ncomplicated by the following issues\n\n#Patient has ongoing delirium ___, with significant waxing\nand waning of her mental status. It was deemed related to pain\nmedications as well as possible labile blood sugars. Medicine \nconsulted and recommended weaning off pain medication and d/c of \noxycontin. She was on oxycodone 2.5 - 5mg q4h prn.\n\n#Hypotension: Resolved with fluid resuscitation. Blood pressures \nnow consistently in\n110's-120's/60-70's. Hgb remained stable a 7.2\n\n#Elevated transaminases\nDowntrending upon her last liver enzyms. RUQUS without \nobstructive pathology, demonstrating e/o steatohepatitis which \npatient is at risk for given poorly\ncontrolled DM and obesity. Hepatitis serologies reveal immunity\nto Hep B and negative for Hepatitis C. Simvastatin was \ndiscontinued\n\n# NSVT\nSome concern for NSVT on tele, although further examination\nsuggesting that this may more likely be artifact and not true \nVT.\nEKG was unconcerning per medicine. \n\n# DM2\nPatient reports home insulin is lantus 30u TID and Humalog 25u\nTID with meals. Was initially hyperglycemic, so insulin regimen\nincreased but patient's mental status worsened and PO intake\ndecreased, resulting in hypoglycemia. She is now on Lantus 30 \nBID\nw/ISS and blood sugars are well controlled. ___ DM team \nrecommend restarting home regimen\n\n# Anemia\nIron studies consistent with iron deficiency anemia and anemia \nof\nchronic disease. Hb was downtrending but as of ___ is stable.\nRecommend continuing to monitor symptoms\n\n# ___ resolved. Cr 1.1 on ___."}}
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{'final_diagnoses': ['lumbar spondylosis', 'delirium', 'Hyperglycemia', 'hypotension', 'hypovolemia', 'anema', 'DMII', 'SVT', 'elevated transaminase enzymes'], 'procedures': ['___ L3-S1 posterior lumbar laminectomy and fusion'], 'visit_summary': "Patient was admitted to Orthopedic Spine Service and underwent \nthe above stated procedure(s). Patient tolerated the procedures \nwell without complication. Please review dictated operative \nreport for details. Patient was extubated without incident and \nwas transferred to PACU then floor in stable condition. \n\n \n\nDuring her course ___ were used for postoperative \nDVT prophylaxis. Intravenous antibiotics were continued for \n24hrs postop per standard protocol. Initial postop pain was \ncontrolled with oral and IV pain medication. Diet was advanced \nas tolerated. Foley was removed in routine fashion and patient \nvoided without incident. Lumbar epidural catheter was removed \non POD#1. Hemovac was removed in routine fashion once the \noutput per 8 hours became minimal. \n\n \n\nPhysical therapy and Occupational therapy were consulted for \nmobilization OOB to ambulate and ADL's. Hospital course was \ncomplicated by the following issues\n\n#Patient has ongoing delirium ___, with significant waxing\nand waning of her mental status. It was deemed related to pain\nmedications as well as possible labile blood sugars. Medicine \nconsulted and recommended weaning off pain medication and d/c of \noxycontin. She was on oxycodone 2.5 - 5mg q4h prn.\n\n#Hypotension: Resolved with fluid resuscitation. Blood pressures \nnow consistently in\n110's-120's/60-70's. Hgb remained stable a 7.2\n\n#Elevated transaminases\nDowntrending upon her last liver enzyms. RUQUS without \nobstructive pathology, demonstrating e/o steatohepatitis which \npatient is at risk for given poorly\ncontrolled DM and obesity. Hepatitis serologies reveal immunity\nto Hep B and negative for Hepatitis C. Simvastatin was \ndiscontinued\n\n# NSVT\nSome concern for NSVT on tele, although further examination\nsuggesting that this may more likely be artifact and not true \nVT.\nEKG was unconcerning per medicine. \n\n# DM2\nPatient reports home insulin is lantus 30u TID and Humalog 25u\nTID with meals. Was initially hyperglycemic, so insulin regimen\nincreased but patient's mental status worsened and PO intake\ndecreased, resulting in hypoglycemia. She is now on Lantus 30 \nBID\nw/ISS and blood sugars are well controlled. ___ DM team \nrecommend restarting home regimen\n\n# Anemia\nIron studies consistent with iron deficiency anemia and anemia \nof\nchronic disease. Hb was downtrending but as of ___ is stable.\nRecommend continuing to monitor symptoms\n\n# ___ resolved. Cr 1.1 on ___.", 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild ', '2. Bisacodyl 10 mg PO/PR DAILY ', '3. Docusate Sodium 100 mg PO BID ', '4. Gabapentin 100 mg PO BID ', '5. Glargine 30 Units Lunch\nInsulin SC Sliding Scale using HUM Insulin ', '6. Senna 8.6 mg PO BID ', '7. Sertraline 100 mg PO DAILY ', '8. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - \nSevere \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*65 Tablet Refills:*0 ', '9. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze, sob ', '10. Carvedilol 12.5 mg PO TID ', '11. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID ', '12. Pantoprazole 40 mg PO Q24H ', '13. Vitamin D 1000 UNIT PO DAILY ', '14. HELD- Citalopram 20 mg PO QAM This medication was held. Do \nnot restart Citalopram until told by pcp']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Dyspnea on exertion', 'medical_history': ['Atrial fibrillation', 'Congestive Heart Failure', 'Mitral Valve Prolapse', 'Mitral Regurgitation', 'Tricuspid Regurgitation', 'Irritable bowel syndrome - no per pt', 'Onychomycosis', 'Osteoarthritis', 'Neuropathy', 'Chronic anemia'], 'family_history': 'Family History: \nNo premature coronary artery disease. Sister with atrial flutter', 'present_illness': 'Mrs. ___ is a ___ year old woman with past medical history of \nmitral valve prolapse and regurgitation followed with serial \nechocardiograms. She recently presented to her PCP with several \ndays of dyspnea on exertion and palpitations. She was found to \nbe in atrial fibrillation and was placed on Metoprolol and \nCoumadin. After several follow-ups with her PCP, she remained in \nAtrialfibrillation and was admitted to ___. She \ncontinued\nto have dyspnea on exertion and also complained of orthopnea, \nparoxysmal nocturnal dyspnea and lower extremity edema. Upon \nadmission she was given further medical management for heart \nfailure and underwent an echocardiogram and cardiac \ncatheterization.\n\nEchocardiogram revealed severe mitral regurgitation with \nprolapse of anterior leaflet and ruptured chordae of flail \nposterior leaflet. Cardiac catheterization demonstrated normal \ncoronaries with elevated right sided filling pressure, moderate \npulmonary hypertension and reduced cardiac output and index. She \nwas admitted pre-operatively for Heparin bridge and pre-op \nwork-up prior to cardiac surgery. She reported a weight gain of \n20lbs since she was seen in clinic. Lasix was increased and \nSpironolactone added to her diuretic regimen. She has since \ndiuresed and was at her dry weight of 133lb.', 'medications': [{'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1231.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.03, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.5', 'valuenum': 52.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '249', 'valuenum': 249.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '260', 'valuenum': 260.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '621', 'valuenum': 621.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.52', 'valuenum': 2.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.5', 'valuenum': 53.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.11', 'valuenum': 2.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '53.9', 'valuenum': 53.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.030', 'valuenum': 1.03, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51.7', 'valuenum': 51.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.06', 'valuenum': 3.06, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.3', 'valuenum': 52.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'BP: 117/88. Heart Rate: 98 AF Resp. Rate: 16. O2 Saturation%: \n100.\nHeight: 64" Weight: 133 lbs\n\nGeneral: Well-developed female in no acute distress\nSkin: Dry [X] intact [X]\nHEENT: PERRLA [X] EOMI [X]\nNeck: Supple [X] Full ROM [X]\nChest: Lungs clear bilaterally [X]\nHeart: RRR [] Irregular [X] Murmur [X] grade ___ systolic\nAbdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds \n+ [X]\nExtremities: Warm [X], well-perfused [X] Edema 2+\nVaricosities: None [X]\nNeuro: Grossly intact [X]\nPulses:\nFemoral Right: 2+ Left: 2+\nDP Right: 2+ Left: 2+\n___ Right: 2+ Left: 2+\nRadial Right: 2+ Left: 2+', 'diagnoses': [{'icd_code': 'S72141A', 'desc': 'Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture'}, {'icd_code': 'T796XXA', 'desc': 'Traumatic ischemia of muscle, initial encounter'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'F0390', 'desc': 'Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety'}, {'icd_code': 'I080', 'desc': 'Rheumatic disorders of both mitral and aortic valves'}, {'icd_code': 'I272', 'desc': 'Other secondary pulmonary hypertension'}, {'icd_code': 'M96830', 'desc': 'Postprocedural hemorrhage of a musculoskeletal structure following a musculoskeletal system procedure'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'W1830XA', 'desc': 'Fall on same level, unspecified, initial encounter'}, {'icd_code': 'Y92013', 'desc': 'Bedroom of single-family (private) house as the place of occurrence of the external cause'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'M25512', 'desc': 'Pain in left shoulder'}, {'icd_code': 'Z8551', 'desc': 'Personal history of malignant neoplasm of bladder'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': 'TEE\nPre-Bypass: \n\nThe left atrium is moderately dilated. No spontaneous echo \ncontrast is seen in the body of the left atrium. No thrombus is \nseen in the left atrial appendage. No atrial septal defect is \nseen by 2D or color Doppler. \nThe left ventricular cavity is mildly dilated. Regional left \nventricular wall motion is normal. Overall left ventricular \nsystolic function is normal (LVEF>55%). Right ventricular \nchamber size and free wall motion are normal. The ascending, \ntransverse and descending thoracic aorta are normal in diameter \nand free of atherosclerotic plaque. The diameters of aorta at \nthe sinus, ascending and arch levels are normal. There are three \naortic valve leaflets. There is no aortic valve stenosis. Trace \naortic regurgitation is seen. There is moderate/severe anterior \nleaflet mitral valve prolapse. There is partial posterior (P3) \nmitral leaflet flail. The mitral regurgitation vena contracta is \n>=0.7cm. Severe (4+) mitral regurgitation is seen. The tricuspid \nvalve leaflets are mildly thickened. Moderate to severe [3+] \ntricuspid regurgitation is seen. The tricuspid regurgitation jet \nis eccentric and may be underestimated. There is no pericardial \neffusion. \n\nPost Bypass: Pt is being AV paced and is on titrated \nphenylephrine and epinephrine infusions. \n\nGlobal LV and RV function remain normal. Mitral regurgitation is \nnow trace\nThere is a well seated 34mm Physio II mitral ring around the \nmitral annulus. The anterior and posterior leaflets do not \nappear restricted. \nTricuspid regurgitation is now trace There is a well seated 30mm \nPhysio tricuspid ring around the tricuspid annulus. Tricuspid \nleaflets appear to be moving without restriction. Other valvular \nstructures remain unchanged. Remainder of the exam is unchanged.\nShe was admitted on ___ for Heparin bridge prior to \nsurgery. She was noted to have an INR of 1.9. She was treated \nwith FFP and Vitamin K for INR reversal prior to surgery. Her \nsurgical date was delayed until her INR was in an acceptable \nrange. She was taken to the operating room on ___ and \nunderwent mitral valve repair with a 34mm Physio II ring, \ntricuspid valve repair with a 30 mm Physio II ring, over sewing \nof the left atrial appendage, and Cryo MAZE procedure (see op \nnote for full details). She tolerated the procedure well and \npost-operatively was transferred to the CVICU in stable \ncondition for recovery and invasive monitoring. \n\nShe weaned from sedation, awoke neurologically intact and was \nextubated on POD 1. She was weaned from inotropic and \nvasopressor support. Beta blocker was initiated and she was \ndiuresed toward her preoperative weight. She remained \nhemodynamically stable and was transferred to the telemetry \nfloor for further recovery. On POD 7 she was seen by \nelectrophysiology for slow ventricular rate of 40 while in \natrial fibrillation. They felt this was due to AV nodal \ninflammation, beta-blockers and amiodarone which was \ndiscontinued. Her ventricular rate increased, low dose \nbeta-blocker was restarted and well tolerated. Coumadin was \nresumed. Chest tubes and pacing wires were discontinued without \ncomplication. She was evaluated by the physical therapy service \nfor assistance with strength and mobility. By the time of \ndischarge on POD 9 she was ambulating freely, the wound was \nhealing, and pain was controlled with oral analgesics. She was \ndischarged home with ___ in good condition with appropriate \nfollow up instructions.'}}
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{'final_diagnoses': ['Mitral Valve Prolapse', 'Mitral Regurgitation', 'Tricupsid Regurgitation', 'Atrial Fibrillation', 'Congestive Heart Failure'], 'procedures': ['Mitral Valve Repair', 'Tricuspid Valve Repair', 'Oversewing of the \nLeft Atrial Appendage', 'CryoMAZE'], 'visit_summary': 'She was admitted on ___ for Heparin bridge prior to \nsurgery. She was noted to have an INR of 1.9. She was treated \nwith FFP and Vitamin K for INR reversal prior to surgery. Her \nsurgical date was delayed until her INR was in an acceptable \nrange. She was taken to the operating room on ___ and \nunderwent mitral valve repair with a 34mm Physio II ring, \ntricuspid valve repair with a 30 mm Physio II ring, over sewing \nof the left atrial appendage, and Cryo MAZE procedure (see op \nnote for full details). She tolerated the procedure well and \npost-operatively was transferred to the CVICU in stable \ncondition for recovery and invasive monitoring. \n\nShe weaned from sedation, awoke neurologically intact and was \nextubated on POD 1. She was weaned from inotropic and \nvasopressor support. Beta blocker was initiated and she was \ndiuresed toward her preoperative weight. She remained \nhemodynamically stable and was transferred to the telemetry \nfloor for further recovery. On POD 7 she was seen by \nelectrophysiology for slow ventricular rate of 40 while in \natrial fibrillation. They felt this was due to AV nodal \ninflammation, beta-blockers and amiodarone which was \ndiscontinued. Her ventricular rate increased, low dose \nbeta-blocker was restarted and well tolerated. Coumadin was \nresumed. Chest tubes and pacing wires were discontinued without \ncomplication. She was evaluated by the physical therapy service \nfor assistance with strength and mobility. By the time of \ndischarge on POD 9 she was ambulating freely, the wound was \nhealing, and pain was controlled with oral analgesics. She was \ndischarged home with ___ in good condition with appropriate \nfollow up instructions.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q4H:PRN pain/temp ', 'Aspirin EC 81 mg PO DAILY ', 'Docusate Sodium 100 mg PO BID ', 'Fluticasone Propionate NASAL 1 SPRY NU BID ', 'Metoprolol Tartrate 12.5 mg PO TID ', 'Warfarin 5 mg PO DAILY16 Duration: 1 Dose \nINR Goal 2.0-3.0 ', 'Furosemide 40 mg PO DAILY ', 'Potassium Chloride 20 mEq PO DAILY \nRX *potassium chloride 20 mEq 1 packet by mouth once a day Disp \n#*30 Packet Refills:*1', 'OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain \nRX *oxycodone 5 mg 1 capsule(s) by mouth every six (6) hours \nDisp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'F', 'symptoms': 'HCC, s/p TACE', 'medical_history': ['Hepatitis C, complicated by cirrhosis with ascites and varices. \nOn liver transplant list.', 'History of IVDU, on methadone maintenance', 'Insulin dependent diabetes mellitus', 'GERD'], 'family_history': 'Negative for liver disease. From OMR, father died of leukemia.', 'present_illness': 'Mr. ___ is a ___ yo man with history of HCV, here for \nmonitoring after TACE for HCC. He has had hepatitis C for \nlikely ___ years, with inability to complete treatment with \ninterferon/ribavirin due to intolerance. He was monitored with \nsurveillance studies and was found to have a suspicious lesion \nin ___, which increased in size over the ensuing year. After \ndiscussion on multiple occasions in liver tumor conference, he \nunderwent a radio frequency ablation and biopsy in ___ which \nconfirmed HCC. Repeat imaging in ___ showed possible evidence \nof persistent disease, and he presented today for TACE. The \nprocedure was unremarkable, and he was subsequently transferred \nto the floor.\n.\nHe feels some mild abdominal pain, but not severe. No nausea, \nno pain in leg or tingling. He did awaken during the procedure, \nand had a leg brace put on to keep his leg steady. \n.\nPrior to the procedure, he was feeling well, although he lost 30 \nlbs over 6 weeks, which he says was intentional. He \noccasionally gets leg cramps. His blood sugars have been \ncontrolled. He has not had a cough, shortness of breath or \nchest pain, or any urinary symptoms. He has some intermittent \nleft anterior shin pain. He had no other pain complaints before \nthe procedure. No jaundice or rashes. ROS otherwise reviewed in \n8 other symptoms and negative.', 'medications': [{'medication': 'Albuterol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.9', 'valuenum': 45.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 52 if non African-American (mL/min/1.73 m2). Estimated GFR = 62 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}], 'exams': 'Exam\n VS T current 96.2 BP 145/74 HR 50 RR 20 100%2L \n O2sat\n\nGen: In NAD. \nHEENT: PERRL, EOMI. No scleral icterus. No conjunctival \ninjection. Mucous membranes moist. No oral ulcers.\nNeck: Supple, no LAD, no JVP elevation.\nLungs: CTA bilaterally (anteriorly), no wheezes, rales, rhonchi. \n Normal respiratory effort.\nCV: RRR, no murmurs, rubs, gallops.\nAbdomen: soft, mild RUQ tenderness, ND, NABS, liver edge \npalpable 3 cm below costal margin. \nExtremities: warm and well perfused, no cyanosis, clubbing, \nedema. Evidence of chronic venous stasis. right leg in brace \npost catheterization, no hematoma or bruit at femoral site. \nNeurological: alert and oriented X 3, CN II-XII intact. Gentle \ntremor, one beat of asterixis.\nSkin: Venous stasis as above.\nPsychiatric: Appropriate.\nGU: deferred.', 'diagnoses': [{'icd_code': '4359', 'desc': 'Unspecified transient cerebral ischemia'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}], 'summary': "Admission labs ___ AM:\n___ 08:15AM UREA N-14 CREAT-0.8 SODIUM-139 POTASSIUM-3.6 \nCHLORIDE-103\n___ 08:15AM ALT(SGPT)-112* AST(SGOT)-375* ALK PHOS-81 TOT \nBILI-0.9\n___ 08:15AM ALBUMIN-3.4* CALCIUM-9.2\n.\n\n___ 08:15AM WBC-7.2 RBC-5.15 HGB-15.4 HCT-43.8 MCV-85 \nMCH-29.9 MCHC-35.1* RDW-13.6\n___ 08:15AM PLT COUNT-169\n___ 08:15AM ___ PTT-26.8 ___\n.\nAbdominal CT ___:\nIMPRESSION: \n1. Ablation zone in segment III of the liver. The superior \naspect exhibits \nslight arterial enhancement and washout which is consistent with \na focus of tumor. \n2. Nodular left adrenal gland, which likely represents \noverlapping limbs, \nthough attention should be paid on followup imaging. \n3. Prominent gastric varices. \n\n.\nAnkle xray ___:\nHISTORY: Increased talar uptake on bone scan. \n \nFINDINGS: Three views of the left ankle are compared to a bone \nscan dated \n___. There are degenerative changes about the \ntibiotalar joint, \nmarked by osteophytosis and subchondral sclerosis. No definite \nlytic or \nsclerotic lesion seen within the talus. However, there is an \nirregularity at the distal fibula with a slight degree of \nlucency, which could be correlated to the bone scan. If further \ncharacterization is required, an MRI would be of utility. No \nfracture. \n \nIMPRESSION: Degenerative changes about the tibiotalar joint. \nIrregularity of the distal fibula, which could be further \ncharacterized by MRI if necessary. \n.\nCT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: There is dependent \natelectasis \nat the imaged portion of lung bases. Triangular-shaped \nground-glass density \nin the lingula with adjacent atelectasis is little changed \ncompared to \n___. The imaged portion of heart and pericardium \nappear \nunremarkable. There has been prior left hepatic lobe \nchemoembolization \nprocedure. Compared to the study of ___, there is \nincrease in \nstranding surrounding the inferior aspect of the left lateral \nsegment with a \ncouple of non-pathologically enlarged adjacent lymph nodes. The \nprevious \nradiofrequency ablation zone in segment III appears unchanged. \nThe overall \nsize of the left hepatic lobe appears similar. A region of \nequivocal \nhypodensity in the right hepatic lobe (2C:14), does not appear \nconspicuous \nwhen viewed in the coronal and sagittal reformations and may be \nperfusional or \npossibly related to unopacified hepatic veins. The gallbladder \nis moderately \ndistended with enhancing mucosa. There is no evidence of \ndirectly \npericholecystic stranding. The appearance is similar to ___. The \npancreas again shows a 1 cm hypodense lesion in the uncinate \nprocess that was \nshown on MRI of ___ to be cystic, and is unchanged \nin size. \nPeriportal lymphadenopathy is mild and stable. Portal vein \nremains patent. \nThere is no biliary or pancreatic ductal dilation. Bilateral \nadrenal glands \nappear unremarkable. The spleen is not enlarged. Varices in the \nleft upper \nquadrant with splenorenal shunt, are unchanged. Bilateral renal \nhypodensities \npreviously shown to represent cysts at MRI, appear unchanged. \nAbdominal aorta \nis normal in caliber and contour with atherosclerotic \ncalcification. \n \nBONE WINDOWS: A sclerotic focus of right anterior rib, and \nadjacent \nadditional rib deformity (300B:21, 23), are consistent with \nposttraumatic \nchange and previously appeared similar. \n \nBONE WINDOWS: No suspicious lytic or sclerotic osseous lesions \nare \nidentified. \n \nIMPRESSION: \n1. Status post TACE to the left hepatic lobe. Interval increase \nin stranding \nof the left hepatic lobe compared to the preceding post-TACE CT \nof ___. The significance of this finding is uncertain. However, \nthere is no \nevidence of abscess collection. \n \n2. Bibasilar atelectasis, but no evidence of frank consolidation \nto suggest \npneumonia as an explanation for the patient's pain. \n \n3. Mildly distended gallbladder with mucosal hyperenhancement, \nhowever, the \nappearance of the gallbladder is unchanged compared to ___. \n \n4. 1 cm cystic lesion of the uncinate process of the pancreas, \nunchanged from \nMRI of ___. Suggest follow up MRI in one year. \n \n5. Bilateral hypodense renal lesions previously shown in MRI to \nrepresent \ncysts.\nMr. ___ is a ___ yo man with history of hepatitis C cirrhosis, \ncomplicated by focal HCC, s/p RFA in ___, here for monitoring \nafter TACE performed for residual disease seen in area of RFA. \nHe is doing well post procedure, but with minimal pain, and a \nsmall amount of asterixis on exam. Pain control will be \ncomplicated by his high methadone dose for methadone \nmaintenance.\n.\n## Hepatocellular carcinoma, s/p TACE.\nThe patient was admitted with standard post TACE orders \n(diuretics, allopurinol, ranitidine, 24 hours of unasyn). The \npatient developed increasing abdominal pain and fever following \nthe procedure. Repeat CT was obtained. Infectious workup was \nnegative. Ciprofloxacin started as per protocol. Pain was \ncontrolled with dilaudid. By hospital day three the patient had \ndefervesced and felt well. His LFTs peaked on the day following \nthe procedure and then trended down. He will follow up with his \noncologist 3 days after discharge.\n.\n## Hepatitis C cirrhosis, complicated by ascites in the past, \nand varices. He had Asterixis on admission; this resolved with \nlactulose. He was continued on his lactulose, lasix 40 mg daily, \naldactone 100 mg po daily. \n.\n## Insulin dependent DM, without complications, controlled. He \nis discharged on his home Novolog regimen.\n.\n## History of substance abuse: Continued Methadone 180 mg po \nbid, dosed at ___ in ___. \n.\n## Left ankle/shin pain. Xray showed possible abnormality.\n- may need to have MRI as outpatient."}}
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{'final_diagnoses': ['Hepatocellular carcinoma', 'cirrhosis'], 'procedures': ['TACE'], 'visit_summary': 'Mr. ___ is a ___ yo man with history of hepatitis C cirrhosis, \ncomplicated by focal HCC, s/p RFA in ___, here for monitoring \nafter TACE performed for residual disease seen in area of RFA. \nHe is doing well post procedure, but with minimal pain, and a \nsmall amount of asterixis on exam. Pain control will be \ncomplicated by his high methadone dose for methadone \nmaintenance.\n.\n## Hepatocellular carcinoma, s/p TACE.\nThe patient was admitted with standard post TACE orders \n(diuretics, allopurinol, ranitidine, 24 hours of unasyn). The \npatient developed increasing abdominal pain and fever following \nthe procedure. Repeat CT was obtained. Infectious workup was \nnegative. Ciprofloxacin started as per protocol. Pain was \ncontrolled with dilaudid. By hospital day three the patient had \ndefervesced and felt well. His LFTs peaked on the day following \nthe procedure and then trended down. He will follow up with his \noncologist 3 days after discharge.\n.\n## Hepatitis C cirrhosis, complicated by ascites in the past, \nand varices. He had Asterixis on admission; this resolved with \nlactulose. He was continued on his lactulose, lasix 40 mg daily, \naldactone 100 mg po daily. \n.\n## Insulin dependent DM, without complications, controlled. He \nis discharged on his home Novolog regimen.\n.\n## History of substance abuse: Continued Methadone 180 mg po \nbid, dosed at ___ in ___. \n.\n## Left ankle/shin pain. Xray showed possible abnormality.\n- may need to have MRI as outpatient.', 'medications_prescribed': ['Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 3 \ndays: DO NOT TAKE THISM MEDICATION AT THE SAME TIME AS YOU TAKE \nYOUR MAGNESIUM.\nDisp:*6 Tablet(s)* Refills:*0*', 'hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every ___ \nhours as needed for pain.\nDisp:*10 Tablet(s)* Refills:*0*', 'clotrimazole 10 mg Troche Sig: One (1) Troche Mucous membrane \n5X/DAY (5 Times a Day).', 'furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Novolog Mix 70-30 100 unit/mL (70-30) Solution Sig: Six (6) \nunits Subcutaneous qAM.', 'lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 \ntimes a day).', 'methadone Oral', 'Methadone\nContinue taking liquid methadone 180 mg twice daily', 'spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'prochlorperazine maleate 10 mg Tablet Sig: One (1) Tablet PO \nQ6H (every 6 hours) as needed for nausea.\nDisp:*8 Tablet(s)* Refills:*0*', 'magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO twice a \nday.', 'ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).\nDisp:*60 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 72, 'gender': 'F', 'symptoms': None, 'medical_history': ['A. flutter on apixaban', 'HTN'], 'family_history': None, 'present_illness': None, 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . Estimated GFR = 71 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '375', 'valuenum': 375.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.12, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.97', 'valuenum': 1.97, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66.2', 'valuenum': 66.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.48', 'valuenum': 4.48, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.17', 'valuenum': 0.17, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.51', 'valuenum': 0.51, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.30', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '44.6', 'valuenum': 44.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 61.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '61.2', 'valuenum': 61.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '232', 'valuenum': 232.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.51', 'valuenum': 4.51, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.3', 'valuenum': 45.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.08, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.03, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '249', 'valuenum': 249.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': None, 'diagnoses': [{'icd_code': 'I5181', 'desc': 'Takotsubo syndrome'}, {'icd_code': 'R9431', 'desc': 'Abnormal electrocardiogram [ECG] [EKG]'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': '___ 10:00PM BLOOD WBC-7.0 RBC-4.71 Hgb-16.0 Hct-46.5 \nMCV-99* MCH-34.0* MCHC-34.4 RDW-13.7 RDWSD-49.7* Plt ___\n___ 04:00PM BLOOD WBC-11.1* RBC-4.55* Hgb-15.1 Hct-45.4 \nMCV-100* MCH-33.2* MCHC-33.3 RDW-14.6 RDWSD-54.0* Plt ___\n___ 10:00PM BLOOD Neuts-45 Bands-1 ___ Monos-22* \nEos-0* Baso-0 Plasma-1* AbsNeut-3.22 AbsLymp-2.17 AbsMono-1.54*\nAbsEos-0.00* AbsBaso-0.00*\n___ 10:00PM BLOOD ___ PTT-45.0* ___\n___ 04:00PM BLOOD ___ PTT-33.8 ___\n___ 10:00PM BLOOD Glucose-85 UreaN-11 Creat-0.8 Na-135 \nK-4.1 Cl-106 HCO3-18* AnGap-11\n___ 04:00PM BLOOD Glucose-112* UreaN-12 Creat-0.9 Na-138 \nK-4.7 Cl-100 HCO3-29 AnGap-9*\n___ 10:00PM BLOOD ALT-9420* AST-2507* LD(LDH)-5195* \nCK(CPK)-86 AlkPhos-160* TotBili-2.1*\n___ 04:00PM BLOOD ALT-4375* AST-1779* LD(LDH)-298* \nTotBili-6.3*\n___ 10:00PM BLOOD Albumin-3.0* Calcium-7.1* Phos-2.6* \nMg-1.6\n___ 04:00PM BLOOD Calcium-8.6 Phos-3.8 Mg-2.1\n___ 10:00PM BLOOD HBsAg-NEG HBsAb-NEG HBcAb-NEG IgM \nHAV-POS*\n___ 06:45AM BLOOD IgM HBc-NEG\n___ 06:45AM BLOOD AMA-NEGATIVE Smooth-NEGATIVE\n___\n___ 06:45AM BLOOD IgG-1631*\n___ 06:45AM BLOOD EBV IgG-POS* EBNA-POS* EBV IgM-NEG \nEBVI-Results in\n___ 06:45AM BLOOD HIV Ab-NEG\n___ 10:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n___ 10:00PM BLOOD HCV Ab-NEG\n___ 10:00PM BLOOD HBV VL-NOT DETECT HCV VL-NOT DETECT\n___ 06:45AM BLOOD CMV VL-NOT DETECT\n\nIMAGING\n___ DUPLEX DOPP ABD/PEL; ABDOMEN US (COMPLETE STUDY)\nFINDINGS: \n \nLIVER: The hepatic parenchyma appears within normal limits. The \ncontour of the \nliver is smooth. There is no focal liver mass.There is no \nascites. \nBILE DUCTS: There is no intrahepatic biliary dilation. \n CHD: Not clearly visualized. No evidence of extrahepatic \nbiliary \ndilatation. \nGALLBLADDER: A dependent mobile echogenic focus measuring up to \n1 cm likely \nrepresents a calculus versus tumefactive sludge. There is no \ngallbladder wall \nthickening. \nPANCREAS: Only the pancreatic head was seen due to bowel gas \nobscuring \nvisualization of the more distal pancreas. Imaged portion of \nthe pancreas \nappears within normal limits, without masses or pancreatic \nductal dilation. \nSPLEEN: Surgically absent. \nKIDNEYS: Limited views of the kidneys show no hydronephrosis. \n Right kidney: 13.7 cm \n Left kidney: 13.4 cm \n \nRETROPERITONEUM: Visualized portions of aorta and IVC are within \nnormal \nlimits. \n \nDOPPLER EVALUATION: \n \nThe main portal vein is patent, with flow in the appropriate \ndirection. \nMain portal vein velocity is 13.9 cm/sec. \nRight and left portal veins are patent, with antegrade flow. \n \nThe main hepatic artery is patent, with appropriate waveform. \nRight, middle and left hepatic veins are patent, with \nappropriate waveforms. \nThe truncated partially visualized splenic vein, and superior \nmesenteric vein \nare patent, with antegrade flow. \n \nIMPRESSION: \n \n1. Patent hepatic vasculature. \n2. Cholelithiasis without evidence of acute cholecystitis.\n___ male PMH A. flutter on apixaban, HTN who presented \nto\nOSH with abdominal pain and weakness. Found to have severe\ntransaminitis and transferred for further work-up. Diagnosed \nwith hepatitis A. LFTs and T ___. Patient was recommended to continue being monitored \nin hospital in setting of liver injury.\nHowever, he decide to leave against medical advice.'}}
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{'final_diagnoses': ['hepatitis A'], 'procedures': ['None'], 'visit_summary': '___ male PMH A. flutter on apixaban, HTN who presented \nto\nOSH with abdominal pain and weakness. Found to have severe\ntransaminitis and transferred for further work-up. Diagnosed \nwith hepatitis A. LFTs and T ___. Patient was recommended to continue being monitored \nin hospital in setting of liver injury.\nHowever, he decide to leave against medical advice.', 'medications_prescribed': ['Metoprolol Succinate XL 50 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'HELD- Apixaban 5 mg PO BID This medication was held. Do not \nrestart Apixaban until PCP ___', 'HELD- Atorvastatin 40 mg PO QPM This medication was held. Do \nnot restart Atorvastatin until hold until pcp approves and liver \nrecovers', 'Outpatient Lab Work\nCBC, LFTs, T ___, direct ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 37, 'gender': 'M', 'symptoms': 'Fatigue and palpitations at rest \npre-op for AVR', 'medical_history': ['Severe Aortic 0.7cm2)', 'Hypertension', 'Paroxysmal atrial fibrillation', 'Left Ventricular hypertrophy', 'Arthritis', 'current tobacco use'], 'family_history': 'Family History: father died MI', 'present_illness': ' year old who presents for\npreoperative admission for bridge from coumadin to heparin with\natrial fibrillation diagnosed in and incidental finding\nof aortic stenosis. Underwent surgical evaluation for aortic\nvalve replacement including cardiac catheterization that \nrevealed\nno coronary artery disease and dental consultation that she \nneeds\nsix teeth extracted.', 'medications': [{'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Buprenorphine-Naloxone (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Loperamide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Buprenorphine-Naloxone (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol Decanoate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (DELayed Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol Decanoate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Buprenorphine-Naloxone (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ziprasidone Mesylate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol Decanoate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Buprenorphine-Naloxone (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cepacol (Menthol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Loperamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Buprenorphine-Naloxone (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ziprasidone Mesylate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol Decanoate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Buprenorphine-Naloxone (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ziprasidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.1', 'valuenum': 52.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '247', 'valuenum': 247.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.46', 'valuenum': 4.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse: 63 Resp: 18 O2 sat: 98%\nB/P \nHeight: Weight: 144.8 Lbs\n\nGeneral: no acute distress \nNeuro: A&Ox3, non focal exam\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] EOMI [x] MMM\nNeck: Supple [x] Full ROM [x] no JVD, \nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur: SEM\nAbdomen: Soft[x] non-distended x] non-tender[x] +bowel sounds \n[x]\nExtremities: Warm [x] well-perfused [x] Edema: none\nVaricosities: None [x]\nPulses:\nFemoral Right: 2+ Left: 2+\nDP Right: 2+ Left: 2+\n Right: 1+ Left: 1+\nRadial Right: 2+ Left: 2+\n\nCarotid Bruit Right: murmur vs bruit Left: murmur vs bruit', 'diagnoses': [{'icd_code': '29530', 'desc': 'Paranoid type schizophrenia, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}], 'summary': 'Admission labs\n 06:18PM URINE BACTERIA-FEW YEAST-NONE \n 06:18PM URINE BLOOD-SM NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-SM\n 06:18PM URINE COLOR-Yellow APPEAR-Clear SP \n 07:15PM PTT-21.9* \n 07:15PM PLT COUNT-326\n 07:15PM WBC-7.7 RBC-4.78 HGB-14.0 HCT-41.0 MCV-86 \nMCH-29.2 MCHC-34.0 RDW-14.3\n 07:15PM %HbA1c-5.8 eAG-120\n 07:15PM ALBUMIN-4.6 CALCIUM-9.9 PHOSPHATE-4.5 \nMAGNESIUM-2.1\n 07:15PM CK-MB-2 cTropnT-<0.01\n 07:15PM LIPASE-22\n 07:15PM ALT(SGPT)-23 AST(SGOT)-16 LD(LDH)-131 \nCK(CPK)-45 ALK PHOS-89 AMYLASE-60 TOT BILI-0.4\n 07:15PM GLUCOSE-120* UREA N-22* CREAT-0.9 SODIUM-140 \nPOTASSIUM-3.8 CHLORIDE-103 TOTAL CO2-28 ANION GAP-13\nDischarge labs\n 04:50AM BLOOD WBC-4.4 RBC-4.60 Hgb-13.1 Hct-39.6 MCV-86 \nMCH-28.6 MCHC-33.2 RDW-14.1 Plt \n 11:17AM BLOOD PTT-58.3*\n 04:50AM BLOOD PTT-54.4* \n 04:50AM BLOOD Glucose-112* UreaN-9 Creat-0.6 Na-141 \nK-3.7 Cl-103 HCO3-29 AnGap-13\n 04:50AM BLOOD Calcium-9.7 Phos-3.6 Mg-2.0\nPatient was adnitted for hepirin bridge while awaiting Aortic \nvalve replacement. During the preop workup it was noted that she \nneeded dental extractions. She was brought to the operating room \nfor extractions on . Following her extractions she spiked a \nfever to 102.3 and it was decided to delay her surgery until she \nhad time to recover from her fever and extractions. She was \nrestarted on Heparin and Coumadin.\nShe was discharged home on . The patient was advised to go \nhome with Lovenox bridge for Atrial fibrillation. She did not \nwant to learn to give herself injections and was willing to \naccept the risk of resuming Coumadin w/o Lovenox bridge.\nShe will followup with Dr office call her in \nthe next several days to confirm new date for surgery and any \nfurther testing that may be indicated.'}}
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{'final_diagnoses': ['s/p multiple teeth extractions', 'PMH:Severe Aortic 0.7cm2), Hypertension, Paroxysmal \natrial fibrillation, Left Ventricular hypertrophy, Arthritis, \ncurrent tobacco'], 'procedures': ['extraction of teeth #1,4,5,11,21,32 and cyst removal from \nright side of the mandible.'], 'visit_summary': 'Patient was adnitted for hepirin bridge while awaiting Aortic \nvalve replacement. During the preop workup it was noted that she \nneeded dental extractions. She was brought to the operating room \nfor extractions on . Following her extractions she spiked a \nfever to 102.3 and it was decided to delay her surgery until she \nhad time to recover from her fever and extractions. She was \nrestarted on Heparin and Coumadin.\nShe was discharged home on . The patient was advised to go \nhome with Lovenox bridge for Atrial fibrillation. She did not \nwant to learn to give herself injections and was willing to \naccept the risk of resuming Coumadin w/o Lovenox bridge.\nShe will followup with Dr office call her in \nthe next several days to confirm new date for surgery and any \nfurther testing that may be indicated.', 'medications_prescribed': ['1. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).\nDisp:*60 Tablet(s)* Refills:*0*', '2. hydrocodone-acetaminophen mg Tablet Sig: Tablets PO \nevery hours as needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', '3. mupirocin calcium 2 % Ointment Sig: One (1) Appl Nasal BID (2 \ntimes a day) for 1 days.\nDisp:*qs 1 day supply* Refills:*0*', '4. clindamycin HCl 300 mg Capsule Sig: Two (2) Capsule PO every \neight (8) hours for 5 days.\nDisp:*30 Capsule(s)* Refills:*0*', '5. warfarin 1 mg Tablet Sig: resume pre admission schedule \nTablet PO once a day: resume pre-admission schedule:\n5mg Q S/T/W/T/S\n7.5mg Q M/F. ', '6. Wellbutrin XL 150 mg Tablet Sustained Release 24 hr Sig: One \n(1) Tablet Sustained Release 24 hr PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 75, 'gender': 'M', 'symptoms': 'Altered mental status and right arm weakness', 'medical_history': ['Tachybrady syndrome with permanent pacemaker placed in ___', 'OSA', 'HTN', 'hyperlipidemia', 'OA', 'BPH', 'R knee replacement'], 'family_history': 'heart disease', 'present_illness': 'History of Present Illness: History obtained from the patient, \nthe patient\'s daughters and ___. \n. \nMr. ___ is an ___ year old man with h/o tachybrady syndrome, \ns/p PPM placement in , OSA, OA, HTN, HLD, who presents with a 5 \nweek h/o worsening neck and R arm pain, altered mental status, \ntransferred from ___ with concern for ___ \nencephalitis. \n. \nSymptoms began on ___, when the patient went to his PCP \nfor fever to 101.5, HA, neck pain and soreness throughout his \narms and above the torso with no chest involvment. He had \nnoticed no rash or tick bites, but he does work in his garden \nfrequently and lives in a wooded area. Multiple neighbors have \ncontracted ___ this summer. At his PCP\'s office (___), he \nhad a ___ test, which was negative. CXR was unremarkable and \nlabs were notable for hyponatremia at 126. Mental status was \nintact at baseline. \n. \nThe patient started to have SOB/heavy breathing 3 days later and \npresented to the ___ ED, where he was given unknown \nantibiotics and prednisone, which temporarily relieved his \nsymptoms. Four weeks later (2 weeks ago), he was admitted to the \nhospital for continued aches and chills without fever. \nRheumatology diagnosed the patient with ? PML and started a \nPrednisone course with taper, of which the patient had taken 3x \n50 mg and 1x 40mg po doses by the time of presentation. A second \n___ test was done and came back positive (___) after he had \nbeen discharged to ___. His symptoms were \nworsening with 5 days of R sided weakness/numbness making him \nunable to hold utensils, "rubbery" lower extremities causing \ngait instability on a walker and 3 days of altered mental \nstatus, involving tangential thinking and incoherent thoughts \nabout "taking screws off his bed and putting them in a cup." \n. \nMultiple CT scans of his head were negative. He was receiving \nnarcotics for the pain. The patient was referred from rehab to \n___ on ___ for concern for arrythmia. EKG \nshowed 1st degree AV block and labs showed persistent \nhyponatremia (124). LP showed elevated protein (126), normal \nglucose (65), +RBCs and WBCs (76 lymphocytes), no organisms. \nHead CT was negative. He was given CTX 2g IV for concern for \n___ meningitis and transferred to ___ for further care. \n. \nIn the ED, initial vs were: T 98.5 P 95 BP 152/82 RR 16 O2sat \n90%4LNC. Labs notable for Na 121. CXR showed bibasilar \natelectasis without consolidation or infiltrate. The patient was \ngiven 3LNS, and broadened with Vancomycin, Ampillin, and \nAcyclovir. He was evaluated by Neuro and thought to have ___ \nencephalitis with brachial radiculitis. Vitals prior to \ntransfer: T 96.1 P ___ BP 160/58 RR 16 O2sat 100%2LNC. \n. \nOn the floor, the patient is currently comfortable and has no \ncomplaints. He is aware that he\'s in the hospital for his ___ \ndisease. \n. \nReview of sytems: \n(+) Per HPI \n(-) Denies fever, chills, night sweats, recent weight loss or \ngain. Denies headache, sinus tenderness, rhinorrhea or \ncongestion. Denied cough, shortness of breath. Denied chest pain \nor tightness, palpitations. Denied nausea, vomiting, diarrhea, \nconstipation or abdominal pain. No recent change in bowel or \nbladder habits. No dysuria.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.5', 'valuenum': 41.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.73', 'valuenum': 4.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'BEGINNING ___, ALL POSITIVE AMPHETAMINE SCREENS;WILL BE SENT FOR CONFIRMATION BY GC/MS;FINAL RESULTS SHOULD BE AVAILABLE IN SEND-OUT SYSTEM 7-10 DAYS LATER.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'METHADONE ASSAY DETECTS ONLY METHADONE (NOT OTHER OPIATES/OPIOIDS).'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OPIATE IMMUNOASSAY SCREEN DOES NOT DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': '>1.050*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 152.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 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None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 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'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.3', 'valuenum': 40.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.51', 'valuenum': 4.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.021', 'valuenum': 1.021, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': 'HOLD. 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{'value': '147', 'valuenum': 147.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.48', 'valuenum': 4.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.60', 'valuenum': 4.6, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = 73 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.1', 'valuenum': 40.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.58', 'valuenum': 4.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73.9', 'valuenum': 73.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '182', 'valuenum': 182.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.1', 'valuenum': 41.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.73', 'valuenum': 4.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.45', 'valuenum': 4.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.85', 'valuenum': 4.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.018', 'valuenum': 1.018, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.76', 'valuenum': 4.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '215', 'valuenum': 215.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.00', 'valuenum': 5.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '232', 'valuenum': 232.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.74', 'valuenum': 4.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'On discharge:\nGeneral: mildly dysarthric, A & O x3 \nHEENT: Sclera anicteric, MMM\nLungs: Clear to auscultation bilaterally posteriorly, no \nwheezes, rales, rhonchi \nCV: RRR, S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nExt: + distal pulses, no clubbing, cyanosis or edema \nNeuro: A & O x3, (on ___ CNII -XII intact except unable to \naccomodate did not check pupillary constriction), ___ weakness \nin R deltoid, ___ in R biceps, and ___ ___, sensation \ngrossly intact', 'diagnoses': [{'icd_code': '1911', 'desc': 'Malignant neoplasm of frontal lobe'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '34280', 'desc': 'Other specified hemiplegia and hemiparesis affecting unspecified side'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '34889', 'desc': 'Other conditions of brain'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V1552', 'desc': 'Personal history of traumatic brain injury'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}], 'summary': "CSF OSH: Traumatic tap at ___ with clearing RBC's and WBC's\nTube 4: WBC 127, RBC 36, Lymphs 93%, Monos 6%\n\nLab tests:\n___ 08:19PM BLOOD WBC-8.9 RBC-4.55* Hgb-13.5* Hct-38.6* \nMCV-85 MCH-29.6 MCHC-34.9 RDW-14.6 Plt ___\n___ 05:00AM BLOOD WBC-10.4 RBC-3.98* Hgb-11.6* Hct-33.9* \nMCV-85 MCH-29.3 MCHC-34.4 RDW-15.0 Plt ___\n___ 08:19PM BLOOD Glucose-123* UreaN-27* Creat-1.1 Na-121* \nK-4.7 Cl-88* HCO3-26 AnGap-12\n___ 08:56AM BLOOD Na-127* K-4.0 Cl-91*\n___ 05:50AM BLOOD Albumin-3.3* Calcium-7.4* Phos-2.3* \nMg-1.9 UricAcd-2.6*\n___ 05:00AM BLOOD Calcium-8.3* Phos-2.6* Mg-2.0\n___ 08:19PM BLOOD ___ PTT-24.5 ___\n___ 04:35PM BLOOD ___\n___ 06:50PM BLOOD ESR-7\n___ 06:50PM BLOOD CRP-18.5*\n___ 05:10AM BLOOD TSH-0.93\n___ 06:50PM BLOOD ALT-29 AST-25 AlkPhos-47 TotBili-0.4\n___ 06:05PM BLOOD Osmolal-262*\n.\nOSH CSF fluid:\n___ CSF HSV ___ PCR not detected\n___ CSF cx nno growth final\n.\n**********PENDING LAB TESTS at ___:\n___ SEROLOGY/BLOOD ___ SEROLOGY\n___ 06:50PM BLOOD ANAPLASMA ___ (HUMAN \nGRANULOCYTIC EHRLICHIA AGENT) ___ HSV PCR pending and blood cx pending\n.\nSodium general trend: 126-> 120 -> 118 -> 119 -> 123 -> 121 -> \n125 -> 126 -> 126 -> 127\n.\nOn ___ urine osm 512, serum osm 262, Urine NA 41, serum NA \n118, serum creatinine 0.8, urine creatinine 116, urine uric acid \n44, serum uric acid 2.5\n.\n___ CT contrast entire spine:\nCT OF THE CERVICAL SPINE WITH IV CONTRAST: The imaged portion of \nthe brain is unremarkable. Mastoid tip air cells are opacified \nbilaterally. \nVertebral body height is normal. There is no evidence of \nendplate erosion tosuggest osteomyelitis. Evaluation of \nintraspinal detail by CT is limited. There is no obvious \nepidural collection, obvious pathologic intrathecal contrast \nenhancement, or obvious pathologic enhancement of the exiting \nnerve roots. \nC2-C3: Left facet arthropathy with mild left neural foraminal \nnarrowing. \nC3-C4: Endplate osteophytes with mild spinal canal narrowing. \nRight \nuncovertebral and bilateral facet arthropathy, with right \ngreater than left neural foraminal narrowing. \nC4-C5: There is a grade I anterolisthesis and bilateral facet \narthropathy. \nThere is no significant canal or neural foramina narrowing. \nC5-C6: There are endplate osteophytes with mild spinal canal \nnarrowing. \nThere are bilateral uncovertebral osteophytes and large left \nfacet \nosteophytes, with moderate-to-severe left and mild-to-moderate \nright neural foraminal narrowing. \nC6-C7: There is a grade I anterolisthesis. There is severe left \nfacet \narthropathy and moderate-to-severe left neural foraminal \nnarrowing. No \nsignificant canal space narrowing is noted. \nC7-T1: No significant neural foraminal or spinal canal narrowing \nis seen. \nTHORACIC SPINE: Vertebral body height and alignment are normal. \nThere is no evidence of endplate erosion to suggest \nosteomyelitis. There is mild multiple endplate spondylosis with \nsmall, predominantly anterior osteophytes. Evaluation of \nintraspinal detail by CT is limited. There is no obvious \nepidural collection, obvious pathologic intrathecal contrast \nenhancement or obvious pathologic enhancement of the exiting \nnerve roots. \nEvaluation of the imaged lungs is limited due to motion. There \nis mild \nbilateral dependent atelectasis. There is a small right pleural \neffusion and trace left pleural fluid. There are coronary artery \ncalcifications, aortic arch calcifications and a pacemaker with \ntwo leads, terminating in the right atrium and right ventricle, \nrespectively. \nLUMBAR SPINE: Vertebral body height is normal. There is no \nevidence of \nendplate erosion to suggest osteomyelitis. Endplate sclerosis at \nL2-3 and \nL4-5, with associated disc space narrowing and disc vacuum \nphenomenon, is \nconsistent with sequela of spondylosis. Evaluation of \nintraspinal detail by CT is limited. There is no obvious \nepidural collection, obvious pathologic intrathecal contrast \nenhancement, or obvious pathologic enhancement of the exiting \nnerve roots. \nL2-3: There is grade 1 retrolisthesis with facet arthropathy, \nresulting in \nmild spinal canal narrowing and bilateral neural foraminal \nnarrowing. \nL3-4: Mild disc bulge without spinal canal or neural foraminal \nnarrowing. \nL4-5: Disc bulge and extensive facet arthropathy. Mild \nflattening of ventral thecal sac. Moderate neural foraminal \nnarrowing. \nL5-S1: Disc bulge and moderate facet arthropathy. Minimal neural \nforaminal \nnarrowing. \nThere are degenerative changes in the sacroiliac joints. \nThere is extensive calcification of the iliac arteries as well \nas the \nabdominal aorta. Subcentimeter hypodensities in the kidneys are \ntoo small to characterize, but statistically are likely to \nrepresent cysts. \nIMPRESSION: \n1. No obvious pathologic intrathecal or nerve root enhancement \nto suggest ___ neuropathy, though CT has limited sensitivity \nfor this type of pathology. \n2. No CT evidence of osteomyelitis or epidural collection. \n3. Multilevel spondylosis in the cervical, thoracic and lumbar \nspine. \n4. Bilateral mastoid tip air cell opacification. \n5. Small right pleural effusion and trace left pleural fluid. \n\nCXR ___:\nLungs are fully expanded and clear. Heart size is normal and \npulmonary \nvasculature is unremarkable. Transvenous right atrial and right \nventricular pacer leads follow their expected courses. No \npleural effusion or evidence of central adenopathy. Thoracic \naorta is generally large and calcified but not focally dilated. \nNo pneumothorax.\n___ yo man with tachy-brady syndrome s/p pacemaker in ___, OA, \nHTN, HLD, p/w 5 weeks of neck pain and upper body aches, then \nright upper extremity weakness, and 3 days of AMS and felt to \nhave disseminated ___ meningitis and possible axillary ___ \nneuropathy. Hospital course complicated by hyponatremia \nsecondary to SIADH and acute renal failure.\n\n#. AMS and ? ___ meningitis/encephalitis: Likely secondary to \ncombination of possible ___ meningitis/encephalitis and \nhyponatremia. Pt was confused prior to transfer from outside \nhospital. His mental status slow improved throughout his \nhospital stay and he is now alert and oriented x3 and coherent. \nHe had occasional slurred speech which waxed and waned and was \nthought to be secondary to a toxic metabolic effect and is now \nmuch improved. His peripheral ___ was 3 bands positive at the \nOSH and a repeat ___ was sent to see if the ___ band was \npositive. His CSF from ___ had no detection but \nthis test is not specific. His CSF cx from OSH had no growth \nfinal and his HSV PCR was pending at the time of transfer and \nneeds to be followed up. He has a blood cx at ___ which \nis currently pending. CT scan at OSH not remarkable and CT spine \nhere did not show evidence of infection. He was initially \ntreated with ampicillin and acyclovir which were discontinued \nwith last dose on ___. He was also initially started on \nceftriaxone 1g IV q 24 hrs which was increased to 2g IV q 24hrs \non ___ with plan for 28 day course (complete on ___ to \ntx disseminated ___. A midline was place of antibiotic \nadministration. He was on steroids prior to admission for \npossible PMH and these were discontined on the day of admission \nto ___."}}
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{'final_diagnoses': ['Meningitis ? ___', 'Hyponatremia with SIADH', 'Tachybrady syndrome with permanent pacemaker placed in \n___', 'OSA', 'HTN', 'hyperlipidemia', 'OA', 'BPH', 'R knee replacement'], 'procedures': ['LP at OSH', 'Midline'], 'visit_summary': '___ yo man with tachy-brady syndrome s/p pacemaker in ___, OA, \nHTN, HLD, p/w 5 weeks of neck pain and upper body aches, then \nright upper extremity weakness, and 3 days of AMS and felt to \nhave disseminated ___ meningitis and possible axillary ___ \nneuropathy. Hospital course complicated by hyponatremia \nsecondary to SIADH and acute renal failure.\n\n#. AMS and ? ___ meningitis/encephalitis: Likely secondary to \ncombination of possible ___ meningitis/encephalitis and \nhyponatremia. Pt was confused prior to transfer from outside \nhospital. His mental status slow improved throughout his \nhospital stay and he is now alert and oriented x3 and coherent. \nHe had occasional slurred speech which waxed and waned and was \nthought to be secondary to a toxic metabolic effect and is now \nmuch improved. His peripheral ___ was 3 bands positive at the \nOSH and a repeat ___ was sent to see if the ___ band was \npositive. His CSF from ___ had no detection but \nthis test is not specific. His CSF cx from OSH had no growth \nfinal and his HSV PCR was pending at the time of transfer and \nneeds to be followed up. He has a blood cx at ___ which \nis currently pending. CT scan at OSH not remarkable and CT spine \nhere did not show evidence of infection. He was initially \ntreated with ampicillin and acyclovir which were discontinued \nwith last dose on ___. He was also initially started on \nceftriaxone 1g IV q 24 hrs which was increased to 2g IV q 24hrs \non ___ with plan for 28 day course (complete on ___ to \ntx disseminated ___. A midline was place of antibiotic \nadministration. He was on steroids prior to admission for \npossible PMH and these were discontined on the day of admission \nto ___.', 'medications_prescribed': ['Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) \nInjection TID (3 times a day).', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) as needed for constipation.', 'Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', 'Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime).', 'Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', 'Pyridoxine 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'Lisinopril 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Ceftriaxone 2 gram Recon Soln Sig: One (1) Intravenous once \na day for 24 days: Total is 28 days of abx started on ___. \nStop date ___..', 'Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) \nPO once a day as needed for constipation.', 'DNR/DNI', 'Chem 7\nPlease follow daily (especially sodium and creatinine) until \nthey normalize or per recs of nephrology team there', 'Lab work\nWeekly Bun/creatine, CBC, and LFTs while on ceftriaxone. All \nlaboratory results should be faxed to Infectious disease\nR.Ns. at ___', 'Out standing labs to follow up Daily\n___', '-f/u blood cx from ___ and ___', '-f/u CSF HSV PCR cx which is still pending', '___ ___', '-ANAPLASMA ___ HUMAN GRANULOCYTIC EHRLICHIA AGENT \nfrom ___', '-___ serology peripheral from ___ to see if ___ band turned \npositive', 'Discontinue foley\nPlease attempt discontinuing foley ___', 'Fluid restriction\nPlease fluid restrict to 1L']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 81, 'gender': 'F', 'symptoms': 'CC: ___ pain and swelling', 'medical_history': ['- CAD: s/p CABG ___ ___, SVG-Diag), s/p Cyper \nDES to SVG->OM in ___', '- Paroxysmal atrial fibrillation x ___, multiple \ncardioversions, a flutter ablations, pulm vein ablation ___, \non dofetilide and coumadin \n(taken off amio for lung dz).', '- s/p ___ pacer ___ for sick sinus syndrome', '- Chronic kidney disease, stage IV. Thought to be from HTN, DM, \nand possibly cardiorenal syndrome. Baseline Cr 2.3-2.8.', '- Hyperlipidemia', '- CVA b/l lacunar ___ with residual left paresthesias and gait \ndysfunction; ', '- DM Type2 ___', '- OSA on CPAP', '- gi bleed on plavix', '- ETOH use: fatty liver- pt denies h/o of problem with EtOH ', '- left ear deafness', '- h/o scarlet fever ', '- Gout', '- Obesity', '- Inflammatory bowel disease'], 'family_history': 'DM2 in multiple relatives', 'present_illness': 'Mr. ___ is a ___ M with a medical history notable for stage IV \nchronic kidney disease, CHF, and type 2 diabetes mellitus on \ninsulin. Here is here for a ___ infection.\n\nHe fell ___ while walking down a flight of stairs. He \nrolled on his ankle though he has no pain in his ankle now and \nis able to ambulate without difficulty. However, on ___ he \nnoted erythema in his leg. On ___ his leg was swollen and \nquite painful.\n\nHe presented to his local ED and was discharged on Keflex. He \nhad minimal improvement and on ___ night (the night prior to \nadmission) he noted increased pain, swelling, and chills. No \nfevers or other associated symptoms. \n\nVitals on arrival to ___ ED: T 98.6, P 67, BP 105/58, 100% on \nRA. A Duplex ultrasound was not suggestive of a DVT. An Xray \nrevealed no foreign bodies and no free air/fluid collection. In \nthe ED he received Vancomycin and Unasyn.\n\nROS: No CP, SOB, urinary symptoms, change in bowel habits.', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Triamcinolone Acetonide 0.1% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 237.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9, . estimated GFR (eGFR) is likely between 60 and 73 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '362', 'valuenum': 362.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.85, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76.5', 'valuenum': 76.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.01', 'valuenum': 1.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.90', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '49.3', 'valuenum': 49.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.12, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.6', 'valuenum': 49.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '83.7', 'valuenum': 83.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 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'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.4', 'valuenum': 49.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.3', 'valuenum': 48.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 115.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '69.7', 'valuenum': 69.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '71.9', 'valuenum': 71.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.5', 'valuenum': 84.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vital Signs: T 98.6, P 72, BP 124/70, 96% on RA.\n\nPhysical examination:\n- Gen: Well-appearing in NAD.\n- HEENT: Using assistive hearing device for left ear\n- Chest: Normal respirations and breathing comfortably on room \nair. Lungs clear to auscultation bilaterally.\n- CV: Unable to palpate PMI. Has large scar on chest from \nprevious sternotomy. Regular rhythm. Normal S1, split S2. No \nmurmurs or gallops. JVP 9 cm. 2+ right carotid and 1+ left \ncarotid. \n- Abdomen: Normal bowel sounds. Soft, nontender, nondistended. \n- ___: left ___ with scar from vein harvesting. No swelling but \ndoes have chronic venous stasis changes. Right leg with similar \nchronic venous stasis changes but also has approx 9cm band of \nerythema and centralized swelling on medial aspect of ___. Has a \nsmall fluid collection in the ___ the swelling. Leg is \nwarm and tender. Has two areas of abrasions that are healing and \nhave dark scabs on them.\n- Neuro: Alert, oriented x3. Good fund of knowledge. CN ___ \nintact except for hearing aid as above. Gait normal. \n- Psych: Appearance, behavior, speech, and affect all normal.', 'diagnoses': [{'icd_code': 'I110', 'desc': 'Hypertensive heart disease with heart failure'}, {'icd_code': 'I5021', 'desc': 'Acute systolic (congestive) heart failure'}, {'icd_code': 'I214', 'desc': 'Non-ST elevation (NSTEMI) myocardial infarction'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I350', 'desc': 'Nonrheumatic aortic (valve) stenosis'}, {'icd_code': 'I482', 'desc': 'Chronic atrial fibrillation'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'I952', 'desc': 'Hypotension due to drugs'}, {'icd_code': 'T447X5A', 'desc': 'Adverse effect of beta-adrenoreceptor antagonists, initial encounter'}, {'icd_code': 'L259', 'desc': 'Unspecified contact dermatitis, unspecified cause'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}], 'summary': 'Chemistries:\n - ___ 05:10PM GLUCOSE-144* UREA N-94* CREAT-2.8* \nSODIUM-135 POTASSIUM-3.8 CHLORIDE-98 TOTAL CO2-26 ANION GAP-15 \nLACTATE-1.6\n\nHematology:\n - ___ 05:10PM WBC-7.2 (NEUTS-79.8* LYMPHS-11.4* \nMONOS-5.0 EOS-3.4 BASOS-0.5) RBC-3.64* HGB-12.1* HCT-34.2* \nMCV-94 MCH-33.4* MCHC-35.5* RDW-17.7* PLT COUNT-161\n\nCoagulation Studies:\n - ___ 05:10PM ___ PTT-42.6* ___\n\nUrine Studies:\n - ___ 06:15PM URINE COLOR-Straw APPEAR-Clear SP \n___ BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG \nKETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n\nXRay: FINDINGS: AP and lateral views of the right tibia and \nfibula demonstrate no evidence of fracture or dislocation. \nLimited views of the knee and ankle joint are unrevealing. Soft \ntissues are unremarkable. IMPRESSION: No acute findings. \n\n___ Ultrasound: No dvt in right lower extremity. Final read \npending.\n\n___ Ultrasound:\nIMPRESSION: \nSonographic appearance of anterior right lower extremity \ncollection is most \nconsistent with an organizing hematoma with a hematocrit level \nnoted. While \nsuperinfection cannot be excluded by imaging, this is felt \nunlikely.\n1. Cellulitis, lower extremity: Likely the result of his fall \nwith skin trauma. Xray negative for fracture. US negative for \nDVT or abscess (only hematoma). Patient failed outpatient \nKeflex. He was started on Vanco/Cefazolin. His cellulitis was \nslow to improve and his regimen was changed to Vanco/Levoflox on \n___. Vanco was increased to 1g q24 and trough was checked \nwhich was appropriate. Given marginal improvement on this \nregimen was changed to unasyn IV, and ID and surgery consulted \n(due to ? abscess centrally). Surgery recommended no I and D \nover concern for poor wound healing following. He improved. I \npassed a needle into a slighly fluctuant central area, but no \npurulence was evident. He was transitioned to oral augmentin \nand continued to improve.\n\n2. Anticoagulation for atrial fibrillation: INR elevated \ninitially. Coumadin was held and restarted at 2.5 mg daily when \nINR 2.8.\n- Resume INR checks as outpatient\n\n3. Type 2 diabetes, uncontrolled: Continued home Lantus qAC \nHumalog dosing with scale\n\n4. CHF, chronic systolic: Slightly volume overloaded on exam. \nIVF were held. Torsemide was continued.\n\n5. Stage IV chronic kidney disease: Stable during this \nadmission. Follow up with nephrologist as outpatient.'}}
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{'final_diagnoses': ['Cellulitis', 'Chronic kidney disease', 'Hypertension', 'Atrial fibrillation', 'Coagulopathy', 'Insulin dependent diabetes mellitus with complications'], 'procedures': ['none'], 'visit_summary': '1. Cellulitis, lower extremity: Likely the result of his fall \nwith skin trauma. Xray negative for fracture. US negative for \nDVT or abscess (only hematoma). Patient failed outpatient \nKeflex. He was started on Vanco/Cefazolin. His cellulitis was \nslow to improve and his regimen was changed to Vanco/Levoflox on \n___. Vanco was increased to 1g q24 and trough was checked \nwhich was appropriate. Given marginal improvement on this \nregimen was changed to unasyn IV, and ID and surgery consulted \n(due to ? abscess centrally). Surgery recommended no I and D \nover concern for poor wound healing following. He improved. I \npassed a needle into a slighly fluctuant central area, but no \npurulence was evident. He was transitioned to oral augmentin \nand continued to improve.\n\n2. Anticoagulation for atrial fibrillation: INR elevated \ninitially. Coumadin was held and restarted at 2.5 mg daily when \nINR 2.8.\n- Resume INR checks as outpatient\n\n3. Type 2 diabetes, uncontrolled: Continued home Lantus qAC \nHumalog dosing with scale\n\n4. CHF, chronic systolic: Slightly volume overloaded on exam. \nIVF were held. Torsemide was continued.\n\n5. Stage IV chronic kidney disease: Stable during this \nadmission. Follow up with nephrologist as outpatient.', 'medications_prescribed': ['1. Torsemide 20 mg Tablet Sig: Three (3) Tablet PO QAM (once a \nday (in the morning)). ', '2. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: Two (2) Tablet Sustained Release 24 hr PO HS (at bedtime). ', '3. Lantus 100 unit/mL Solution Sig: 25, 50 units Subcutaneous as \ndirected: 25 units in AM, 50 units in ___. ', '4. Novolog 100 unit/mL Solution Sig: ___ units Subcutaneous \nthree times a day: with meals according to your sliding scale. ', '5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily). ', '6. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '7. Allopurinol ___ mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '8. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO HS (at \nbedtime). ', '9. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '10. Acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain. ', '11. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '12. Calcium Carbonate 500 mg (1,250 mg) Capsule Sig: One (1) \nCapsule PO once a day. ', '13. Multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '14. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) as \nneeded for constipation. ', '15. Oxycodone 5 mg Tablet Sig: 1 - 1.5 Tablet PO Q6H (every 6 \nhours) as needed for pain: do not drink alcohol or drive with \nthis medication.\nDisp:*45 Tablet(s)* Refills:*0*', '16. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1) \nTablet PO Q12H (every 12 hours) for 1 weeks: take until redness \nresolves on leg - if you need more than one week of treatment \nfor this, discuss it with Dr. ___ you see him next \n___. \nDisp:*14 Tablet(s)* Refills:*0*', '17. Miralax 17 gram Powder in Packet Sig: One (1) packet PO once \na day as needed for constipation.\nDisp:*30 packet* Refills:*0*', '18. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO ___, \nWEd, ___. ', '19. Coumadin 5 mg Tablet Sig: One (1) Tablet PO ___.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 66, 'gender': 'F', 'symptoms': 'Word-Finding Difficulties', 'medical_history': ['- Biclonal gammopathy (as per outpatient mhematologist, based on \nSPEP/BMBX in ___ ', '- AIHA (DAT+, found in ___, now on prednisone) ', '- Subarachnoid hemorrhage s/p coiling ___ c/b vasospasm ', '- Sleep Apnea (uses CPAP and longstanding severe clubbing of \nunclear etiology) ', '- Left eye strabismus ', '- Per brother/HCP, patient spent first 6 months of life in \n___ w ? cardiac abnormality. (TTE from PCP \nshowed ___ MR, normal LVEF, no other abnormalities. PCP \nwas unaware of this history and has no further records) ', '- Vitamin D deficiency ', '- Hypertension ', '- Congenital deformity of foot'], 'family_history': "- 2 uncles with cerebral aneurysms \n- No history of connective issue disease/Marfan's", 'present_illness': 'Mr. ___ is a ___ year-old gentleman known to the \nNeurosurgery service. He was recently discharged on ___ after \nundergoing an elective left MCA aneurysm on ___. At the time \nof discharge, Mr. ___ was neurologically intact, aside from \nhis baseline disconjugate gaze. He lives at home with his \n___. The patient says he was doing well at home \ninitially, but could not tell me when he became confused or \nbegan to have speech difficulties.\n\nAccording to his sister, ___, she spoke to her brother on \n___, ___ and he sounded well and like himself (baseline). \nShe did not speech to him ___ (day of discharge). When she \ncalled him yesterday evening, ___, he was unable to answer her \nquestions, would say "ummm" frequently (as if searching for \nwords), and would not stay on topic. Due to ongoing concerns, \n___ went to Mr. ___ home this morning, ___. After \ndiscussing his condition with a family relative (and employee of \n___, she brought the patient to the ED for evaluation.\n\nUpon arrival in the ED, a Code Stroke was called. Neurology saw \nthe patient at that time. A CT/CTA of the head was obtained and \nwas concerning for a left temporal-parietal intraparenchymal \nhemorrhage. \n\nMr. ___ denied any falls, loss of consciousness, \nnumbness/tingling in arms or legs. Due to his expressive \naphasia, it was difficult to elicit a more extensive review of \nsystems.', 'medications': [{'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meclizine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.56', 'valuenum': 2.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.92', 'valuenum': 2.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAM (ADMISSION):\nO: T98.6 HR 102 BP 133/78 RR 20 O2 sat 98% on room air\nGen: WD/WN, comfortable, NAD.\nHEENT: PERRL, disconjugate gaze, R lateral nystagmus\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nLanguage: Dysarthric with word-finding difficulties, speech\nhesitancy.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light. Visual fields\nare full to confrontation.\nIII, IV, VI: Disconjugate gaze with right lateral nystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. Right pronation of hand\nwith no drift.\n\nSensation: Intact to light touch throughout.\n\nToes downgoing bilaterally.\n\nRight handed.\n\n_____________\n\nPHYSICAL EXAM (DISCHARGE):\nAwake, alert, oriented x 3. No acute distress. \nSpeech fluent. No dysarthria. Naming/repetition intact. Mild \nspeech hesitancy.\nPERRL, Disconjugate gaze with right lateral nystagmus.\nFace symmetric, tongue midline. \nMoves all extremities with full strength throughout. Sensation \nintact to LT. \nLeft cranial incision closed with sutures, clean/dry/intact, \nwell-healing without evidence of erythema, drainage, swelling.', 'diagnoses': [{'icd_code': '82009', 'desc': 'Other closed transcervical fracture of neck of femur'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '4580', 'desc': 'Orthostatic hypotension'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': 'E8499', 'desc': 'Accidents occurring in unspecified place'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}], 'summary': "CT/CTA Head (___): \n1. Clipped and coiled left parietal M4 segment middle cerebral \nartery aneurysm with expected postsurgical changes including \npneumocephalus, left frontoparietal convexity blood products, \nand mild left-to-right midline shift. No of residual filling of \nthe aneurysm by CTA, however there is significant streak \nartifact which obscures adjacent structures. \n2. Small parenchymal hemorrhage inferior and medial to the \naneurysm. \n3. Patent intracranial and neck vasculature without additional \naneurysm, occlusion, or stenosis. \n\nCXR (___): \nMarked cardiomegaly with mild pulmonary vascular congestion.\n\nMRI Brain (___): \n1. No evidence of acute infarct allowing for susceptibility \nartifact in the left superior temporal lobe and angular gyrus \nfrom coil embolization and aneurysm clipping material. \n2. Expected postsurgical changes after aneurysm clipping, \nincluding intraparenchymal edema with minimal mass effect upon \nthe adjacent occipital horn of the left lateral ventricle, \npneumocephalus, superficial soft tissue swelling, and \nsusceptibility artifact from coiling and clipping material. \n3. Hemorrhage/residual postoperative blood products inferior to \nthe surgical site, as seen on CT head from the day prior, with \nassociated surrounding FLAIR hyperintense edema pattern \ninvolving the left superior temporal lobe and Wernicke's area as \nwell as the more superior frontal parietal lobe. \n4. No flow-limiting stenosis or occlusion identified within the \nintracranial vasculature. No residual aneurysm visualized \nalthough the more distal left MCA segments cannot be reliably \nevaluated secondary to susceptibility artifact. \n5. Unchanged a right posterior nasal cavity and anterior \nnasopharynx polypoid lesion is re-identified. \n\nMRI & CTA reports preliminary at time of discharge. However, all \nstudies were reviewed by the attending physician.\nMr. ___ was admitted to ___ on ___ after mutliple \nepisodes of self-limiting word-finding difficulties. His \nsymptoms had resolved upon arrival. He denied any additional \nneurologic deficits, including numbness or weakness in \nextremities, headaches, or visual changes. He underwent CTA \nwhich demonstrated post-operative changes from his left \ncraniotomy for aneurysm clipping on ___. He was admitted to \nthe ICU for close neurological monitoring. Pressors were \ninitiated for blood pressure augmentation due to concern for new \nstroke. MRI was performed and failed to show evidence of new \ninfarct. At this time, his pressors were weaned to off. His \nsymptoms are likely due to post-operative cerebral edema, and he \nwas started on high-dose Dexamethasone. He was subfebrile in ED \n(101.2), and blood and urine cultures were sent. Urine was \npositive for Enterococcus, and he will be treated with \nCiprofloxacin x 3 Blood cultures showed no growth as of \ndischarge. He remained clinically stable throughout \nhospitalization. He was evaluated by ___, who recommended \ndischarge home with family support. At time of discharge, he was \nneurologically intact. Will discharge home with close \nneurosurgical follow-up."}}
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{'final_diagnoses': ['Cerebral edema', 'Expressive aphasia'], 'procedures': ['None'], 'visit_summary': 'Mr. ___ was admitted to ___ on ___ after mutliple \nepisodes of self-limiting word-finding difficulties. His \nsymptoms had resolved upon arrival. He denied any additional \nneurologic deficits, including numbness or weakness in \nextremities, headaches, or visual changes. He underwent CTA \nwhich demonstrated post-operative changes from his left \ncraniotomy for aneurysm clipping on ___. He was admitted to \nthe ICU for close neurological monitoring. Pressors were \ninitiated for blood pressure augmentation due to concern for new \nstroke. MRI was performed and failed to show evidence of new \ninfarct. At this time, his pressors were weaned to off. His \nsymptoms are likely due to post-operative cerebral edema, and he \nwas started on high-dose Dexamethasone. He was subfebrile in ED \n(101.2), and blood and urine cultures were sent. Urine was \npositive for Enterococcus, and he will be treated with \nCiprofloxacin x 3 Blood cultures showed no growth as of \ndischarge. He remained clinically stable throughout \nhospitalization. He was evaluated by ___, who recommended \ndischarge home with family support. At time of discharge, he was \nneurologically intact. Will discharge home with close \nneurosurgical follow-up.', 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN pain ', '2. Docusate Sodium 100 mg PO BID \nOTC medication ', '3. Senna 8.6 mg PO BID:PRN Constipation \nOTC medication ', '4. Lisinopril 10 mg PO DAILY ', '5. Furosemide 40 mg PO BID ', '6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN \nmoderate-severe pain \nDo not drive or drink alcohol while taking this medication. ', '7. Dexamethasone 4 mg PO Q6H \nTAPER: 4mg q6h ___, 4mg q8h ___, 4mg q12h ___, then \nresume home dose of Prednisone \nThis is dose # of tapered doses\nTapered dose - DOWN \nRX *dexamethasone 4 mg 1 tablet(s) by mouth TAPER Disp #*25 \nTablet Refills:*0', '8. PredniSONE 20 mg PO DAILY \nResume after Decadron taper completed ', '9. LeVETiracetam 500 mg PO BID \nRX *levetiracetam [___] 500 mg 1 tablet(s) by mouth twice a \nday Disp #*60 Tablet Refills:*1', '10. Aspirin 325 mg PO DAILY \nRX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*1', '11. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days \nRX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice \na day Disp #*6 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 29, 'gender': 'M', 'symptoms': 'Acute Pancreatitis', 'medical_history': ['Type 2 DM', 'Schizoaffective Disorder'], 'family_history': 'No family history of pancreatitis, hypertriglyceridemia per \npatient', 'present_illness': '___ is a ___ year old male patient with a history of Type \n2\nDM poorly controlled, schizoaffective disorder who presented \n___\nwith abdominal pain found to have acute pancreatitis in the\nsetting of hypertriglyceridemia.\n\nMr. ___ symptoms began ___ he developed a moderate, dull\npain in his lower back. On the morning of admission, he woke up\nfeeling feverish, and as soon as he got up he had severe\nabdominal pain. He describes the pain as sharp, stabbing, and\ncrampy, worst in the epigastric region although he also feels it\nthroughout his abdomen, and continues to feel it in his back and\nhis L-sided chest and ribcage. It was unrelated to position. \n\nNotably on presentation his triglycerides were noted to be above\n4000 with lipase ___ prompting ICU transfer for initiation of\nan insulin gtt as medical management of pancreatitis. His course\nat ___ was additionally notable for the onset of fevers,\ntachycardia. \n\nLabs prior to transfer were notable for Phosph 1.6, Calcium 7.8,\nTriglycerides 1722, WBC 9.6, Hgb 12.4. \n\nAbdominal US ___: 1. No cholelithiasis or biliary\ndilatation. \n 2. Hepatic steatosis and/or fibrosis with focal sparing. \n\nCXR ___: IMPRESSION: Normal chest radiographs. \n\nOn arrival to the floor, Mr. ___ notes that earlier in the \nweek\nhe was not experiencing abdominal pain but had trouble sleeping\nand was taking ___ Advil ___. It was not until day of\npresentation to ___ did he note abdominal pain. He notes that he\nhas not had recent medication changes, no recent travel. He is\naware of Type 2 DM diagnosis but not currently any therapy. He\nnotes a mild headache currently, minimal abdominal pain and\nintermittent nausea.', 'medications': [{'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Buprenorphine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Divalproex (EXTended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'ug/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 12.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.08', 'valuenum': 5.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POS*. Benzodiazepine immunoassay screen does not reliably detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '29', 'valuenum': 29.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-62', 'valuenum': -62.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-45', 'valuenum': -45.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POS*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POS*. Benzodiazepine immunoassay screen does not detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Methadone assay detects Methadone (not other Opiates/Opioids). Quetiapine (Seroquel) may cause a false positive result.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POS*. Opiate assay does not reliably detect synthetic opioids. such as Methadone, Oxycodone, Fentanyl, Buprenorphine, Tramadol,. Naloxone, Meperidine. See online Lab Manual for details.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '74', 'valuenum': 74.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4182', 'valuenum': 4182.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-429', 'valuenum': -429.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-261', 'valuenum': -261.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-74', 'valuenum': -74.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-463', 'valuenum': -463.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM \nVS: BP 125/61 HR 108 SpO 95% \nGEN:Lying in bed, non-toxic appearing\nCV:RRR, no chest wall tenderness\nPULM: clear to auscultation in anterior fields, mild bibasilar\ncrackles\nABD:Soft, non-distended, mildly tender to palpation in \nepigastric\narea s/p morphine\nEXT:Warm well-perfused, non pitting edema present in lower\nextremities and hands\n\nDISCHARGE EXAM: \nAVSS\nGEN: sitting in chair in NAD\nCV:RRR, no chest wall tenderness\nPULM: clear to auscultation in anterior fields, mild bibasilar\ncrackles\nABD:Soft, non-distended, nontender\nEXT:Warm well-perfused, no edema\nPsych: odd affect, but linear though process, calm', 'diagnoses': [{'icd_code': 'R569', 'desc': 'Unspecified convulsions'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'B1920', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': 'F1910', 'desc': 'Other psychoactive substance abuse, uncomplicated'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'Z590', 'desc': 'Homelessness'}, {'icd_code': 'Z87820', 'desc': 'Personal history of traumatic brain injury'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}], 'summary': '___ 08:52PM BLOOD WBC-11.3* RBC-4.13* Hgb-12.4* Hct-37.0* \nMCV-90 MCH-30.0 MCHC-33.5 RDW-12.3 RDWSD-40.4 Plt ___\n___ 08:52PM BLOOD Plt ___\n___ 08:52PM BLOOD Glucose-129* UreaN-5* Creat-0.9 Na-136 \nK-4.3 Cl-101 HCO3-18* AnGap-17\n___ 08:52PM BLOOD ALT-16 AST-15 LD(LDH)-268* AlkPhos-80 \nTotBili-0.5\n___ 08:52PM BLOOD Calcium-8.8 Phos-1.9* Mg-2.1\n___ 08:52PM BLOOD %HbA1c-10.3* eAG-249*\n___ 12:25AM BLOOD ___ pH-7.46*\n___ 12:25AM BLOOD freeCa-1.17\n\nSIGNIFICANT LABS:\n=================\n___ 08:52PM BLOOD Triglyc-1426*\n___ 03:44AM BLOOD Triglyc-1119*\n___ 01:19PM BLOOD Triglyc-1084*\n___ 08:34PM BLOOD Triglyc-1067*\n___ 04:04AM BLOOD Triglyc-982*\n___ 12:05PM BLOOD Triglyc-855*\n\nDISCHARGE LABS:\n=============\n___ 04:04AM BLOOD WBC-9.4 RBC-3.65* Hgb-10.8* Hct-33.7* \nMCV-92 MCH-29.6 MCHC-32.0 RDW-12.5 RDWSD-42.4 Plt ___\n___ 04:04AM BLOOD Glucose-105* UreaN-4* Creat-0.7 Na-136 \nK-3.3* Cl-103 HCO3-19* AnGap-14\n___ is a ___ year old male patient with diabetes \npresenting with epigastric pain found to have pancreatitis in \nthe setting of hypertriglyceridemia, transferred to ___ for \nfurther management.\n\n# Hypertriglyceridemia-induced pancreatitis:\n# Hypertriglyceridemia \nHypertriglyceridemia likely in the setting of poorly controlled \nType 2 DM. TSH WNL at CHA and no other medication use associated \nwith hypertriglyceridemia His abdominal US was without \ngallstones and alcohol use is limited so other etiologies less \nlikely. He was admitted to the ICU and started on dextrose ggt \nwith insulin ggt to reduce his ___. His TGs improved from 1426 to \n855 and he was transitioned from an insulin ggt to subQ insulin \nand called out to the floor. In addition, he was started on \nfenofibrate 145 mg daily. Patient tolerating diet. Upon arrival \nto the medical floor from the ICU, the patient elected to leave \nAGAINST MEDICAL ADVICE. \n\n# T2DM: \nNot on medication. From chart review, was diagnosed in ___. \nHgA1c 10.8%. Seen by ___ who was providing recommendations \nfor insulin regimen but patient ultimately chose to leave AMA. \nHe was not discharged on insulin as this was deemed to be unsafe \ngiven incomplete diabetic education on appropriate use. \n\n# Schizoaffective disorder/Agoraphobia:\nPer chart, has limited patients ability to optimally achieve \ncontinuity of outpatient care, particularly for his diabetes. \nPatient with linear thought process without evidence of \npsychiatric decompensation interfering his ability to make \ninformed decisions.\n\n# AMA Discharge: \nPatient expressed desire to leave against medical advice because \nhe strongly disliked being in the hospital. His thought process \nwas linear and there was no concern for decompensated \npsychiatric illness interfering with his decision making. The \npatient exhibited understanding of his reason for \nhospitalization, benefits of continuing to optimize his diabetic \ncare, and risks of leaving too soon which include, but are not \nlimited to, recurrent pancreatitis that may lead to repeat ICU \nhospitalization. He endorsed understanding that severe \npancreatitis can be fatal and states that he would return to the \nhospital if he felt that he was getting sick again. '}}
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{'final_diagnoses': ['# acute pancreatitis', '# DM2'], 'procedures': ['none'], 'visit_summary': '___ is a ___ year old male patient with diabetes \npresenting with epigastric pain found to have pancreatitis in \nthe setting of hypertriglyceridemia, transferred to ___ for \nfurther management.\n\n# Hypertriglyceridemia-induced pancreatitis:\n# Hypertriglyceridemia \nHypertriglyceridemia likely in the setting of poorly controlled \nType 2 DM. TSH WNL at CHA and no other medication use associated \nwith hypertriglyceridemia His abdominal US was without \ngallstones and alcohol use is limited so other etiologies less \nlikely. He was admitted to the ICU and started on dextrose ggt \nwith insulin ggt to reduce his ___. His TGs improved from 1426 to \n855 and he was transitioned from an insulin ggt to subQ insulin \nand called out to the floor. In addition, he was started on \nfenofibrate 145 mg daily. Patient tolerating diet. Upon arrival \nto the medical floor from the ICU, the patient elected to leave \nAGAINST MEDICAL ADVICE. \n\n# T2DM: \nNot on medication. From chart review, was diagnosed in ___. \nHgA1c 10.8%. Seen by ___ who was providing recommendations \nfor insulin regimen but patient ultimately chose to leave AMA. \nHe was not discharged on insulin as this was deemed to be unsafe \ngiven incomplete diabetic education on appropriate use. \n\n# Schizoaffective disorder/Agoraphobia:\nPer chart, has limited patients ability to optimally achieve \ncontinuity of outpatient care, particularly for his diabetes. \nPatient with linear thought process without evidence of \npsychiatric decompensation interfering his ability to make \ninformed decisions.\n\n# AMA Discharge: \nPatient expressed desire to leave against medical advice because \nhe strongly disliked being in the hospital. His thought process \nwas linear and there was no concern for decompensated \npsychiatric illness interfering with his decision making. The \npatient exhibited understanding of his reason for \nhospitalization, benefits of continuing to optimize his diabetic \ncare, and risks of leaving too soon which include, but are not \nlimited to, recurrent pancreatitis that may lead to repeat ICU \nhospitalization. He endorsed understanding that severe \npancreatitis can be fatal and states that he would return to the \nhospital if he felt that he was getting sick again. ', 'medications_prescribed': ['Fenofibrate 145 mg PO DAILY \nRX *fenofibrate nanocrystallized 145 mg 1 tablet(s) by mouth \nonce a day Disp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'F', 'symptoms': 'abdominal and back pain', 'medical_history': ['sleep apnea (not on CPAP)', 'hypothyroid', 'HTN', 'HLD', 'LEFT KNEE PAIN', 'MITRAL REGURGITATION', 'OSTEOARTHRITIS', 'OVARIAN CYSTS', 'PANCREATITIS', 's/p ERCP notable for incomplete pancreas divisum'], 'family_history': 'Mother: OA, passed away from car accident\nFather: CAD, prostate cancer, passed away from MI\nSister: HTN \nBrother: HTN and OA', 'present_illness': '___ w/ hx HTN, HLD, s/p hysterectomy p/w abdominal pain. \n\nPt reports onset of ___ RUQ and right sided back pain 2 nights \nago. Pain radiates from back to front, is associated w/ food, \nnot relieved by tums. Did not have n/v at home, and denies d/c, \nblack/bloody stools, dysuria, chest pain, sob. No fevers, \nchills, reflux, heartburn. No ETOH use.\n\nIn ED, VS: T 99.0, HR 93, BP 144/74, RR 16, O2 99%. Labs: wbc \n11.5, UA +bact/leuk/epi, LFTs/lip wnl. CT a/p: blurring of \nmargins of the pancreatic head and uncinate process with mild \nperipancreatic edema and stranding may represent early acute \npancreatitis. Given acetaminophen 1000mg and ketorolac 30mg, \npain improved. She had one episode of clear emesis after po \nmeds.\n\nCurrently, pain is ___, continues to have some mild nausea.\n\nROS: + chronic right shoulder/hand pain; otherwise 12 point \nreview of system is negative.', 'medications': [{'medication': 'Golytely', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'X1', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Discontinued', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'J TUBE', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'J TUBE', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '484', 'valuenum': 484.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.7', 'valuenum': 22.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '497', 'valuenum': 497.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.21', 'valuenum': 4.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '587', 'valuenum': 587.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.16', 'valuenum': 4.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11-20', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Cloudy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '>50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '442', 'valuenum': 442.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '418', 'valuenum': 418.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 8.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.8', 'valuenum': 22.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74.1', 'valuenum': 74.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '336', 'valuenum': 336.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.03', 'valuenum': 3.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'OCC', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21-50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.010', 'valuenum': 1.01, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SlHazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Straw', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CLUMPS PRESENT.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '432', 'valuenum': 432.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'VS: 98.8, 135/78, 69, 20, 99% RA\nGen: Well appearing, NAD\nHEENT: OP clear, mmm, PERRL, EOMI\nNeck: Supple, no thyromegaly, no LAD\nCV: RR, no murmurs/rubs\nPulm: CTAB, no wheeze/rales\nAbd: Soft, NABS, minimally TTP along RUQ, no HSM\nGU: No CVAT\nExt: WWP, no edema\nMSK: No spinal tenderness\nSkin: No rash', 'diagnoses': [{'icd_code': '1501', 'desc': 'Malignant neoplasm of thoracic esophagus'}, {'icd_code': '5934', 'desc': 'Other ureteric obstruction'}, {'icd_code': '591', 'desc': 'Hydronephrosis'}, {'icd_code': '5601', 'desc': 'Paralytic ileus'}, {'icd_code': '59010', 'desc': 'Acute pyelonephritis without lesion of renal medullary necrosis'}, {'icd_code': '79001', 'desc': 'Precipitous drop in hematocrit'}, {'icd_code': '5997', 'desc': 'Hematuria'}, {'icd_code': '78720', 'desc': 'Dysphagia, unspecified'}, {'icd_code': '2189', 'desc': 'Leiomyoma of uterus, unspecified'}, {'icd_code': '0414', 'desc': 'Escherichia coli [E. coli] infection in conditions classified elsewhere and of unspecified site'}], 'summary': '___ 10:00PM URINE MUCOUS-RARE\n___ 10:00PM URINE RBC-<1 WBC-5 BACTERIA-FEW YEAST-NONE \nEPI-<1\n___ 10:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-MOD\n___ 10:00PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 10:20PM PLT COUNT-224\n___ 10:20PM NEUTS-77.8* LYMPHS-17.5* MONOS-4.1 EOS-0.2 \nBASOS-0.4\n___ 10:20PM WBC-11.5*# RBC-4.53 HGB-13.0 HCT-37.0 MCV-82 \nMCH-28.7 MCHC-35.2* RDW-13.0\n___ 10:20PM ALBUMIN-4.5\n___ 10:20PM LIPASE-30\n___ 10:20PM ALT(SGPT)-24 AST(SGOT)-18 ALK PHOS-74 TOT \nBILI-1.1\n___ 10:20PM estGFR-Using this\n___ 10:20PM GLUCOSE-113* UREA N-12 CREAT-0.7 SODIUM-134 \nPOTASSIUM-3.4 CHLORIDE-94* TOTAL CO2-29 ANION GAP-14\n\nCT a/p:\nblurring of margins of the pancreatic head and uncinate process \nwith mild \nperipancreatic edema and stranding may represent early acute \npancreatitis; correlate with lipase and clinical findings. \nno renal calculi or hydronephrosis.\n___ w/ hx HTN, HLD, s/p hysterectomy admitted with right flank \nand right sided back pain.\n.\n#FLANK PAIN: The patient presented with an episode of right \nsided abdominal, flank, and back pain. LFT and lipase were \nwithin normal limits. CT abdomen showed an unremarkable liver \nand gallbladder, no renal calculi, and changes consistent with \nmild early acute pancreatitis. RUQ u/s showed gallbladder that \nwas free of stones without bile duct dilation. The clinical \npresentation was atypical for acute pancreatitis given \ndistribution of pain and normal lipase but this may be likely \ndiagnosis given CT findings. She may have pancreatic divisum as \nwas told ___ years ago during EGD/ERCP that had abnormal \npancreatic duct anatomy. Gastritis or peptic ulcer disease also \nconsidered, for which a PPI was started. Pulmonary etiology \nconsidered although no respiratory symptoms and normal CXR. She \nwas treated initially with IVF, pain control with IV dilaudid \n(ADR to many other medications), and NPO. Her diet was soon \nadvanced and she was tolerating a regular diet at the time of \ndischarge. Her pain resolved during the hospitalization. Would \nconsider further outpatient GI evaluation. Consider stopping \nomeprazole after ___ week trial period. \n.\n#ADRENAL NODULE: Noted on CT abdomen was a 14mm x 9mm adrenal \nnodule consistent with an adenoma. Would consider further \nevaluation for incidental adrenal finding with labs (renin, \naldosterone, urine metanephrines, AM cortisol) and imaging to \nensure stability. \n.\nCHRONIC ISSUES: \n# HTN: Cont home medications\n# HLD: Restart home statin at the time of discharge \n# Hypothyroid disease: Cont synthroid\n. \nTRANSITIONAL ISSUES: \n-consider further GI outpatient evaluation'}}
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{'final_diagnoses': ['Pancreatitis'], 'procedures': ['None'], 'visit_summary': '___ w/ hx HTN, HLD, s/p hysterectomy admitted with right flank \nand right sided back pain.\n.\n#FLANK PAIN: The patient presented with an episode of right \nsided abdominal, flank, and back pain. LFT and lipase were \nwithin normal limits. CT abdomen showed an unremarkable liver \nand gallbladder, no renal calculi, and changes consistent with \nmild early acute pancreatitis. RUQ u/s showed gallbladder that \nwas free of stones without bile duct dilation. The clinical \npresentation was atypical for acute pancreatitis given \ndistribution of pain and normal lipase but this may be likely \ndiagnosis given CT findings. She may have pancreatic divisum as \nwas told ___ years ago during EGD/ERCP that had abnormal \npancreatic duct anatomy. Gastritis or peptic ulcer disease also \nconsidered, for which a PPI was started. Pulmonary etiology \nconsidered although no respiratory symptoms and normal CXR. She \nwas treated initially with IVF, pain control with IV dilaudid \n(ADR to many other medications), and NPO. Her diet was soon \nadvanced and she was tolerating a regular diet at the time of \ndischarge. Her pain resolved during the hospitalization. Would \nconsider further outpatient GI evaluation. Consider stopping \nomeprazole after ___ week trial period. \n.\n#ADRENAL NODULE: Noted on CT abdomen was a 14mm x 9mm adrenal \nnodule consistent with an adenoma. Would consider further \nevaluation for incidental adrenal finding with labs (renin, \naldosterone, urine metanephrines, AM cortisol) and imaging to \nensure stability. \n.\nCHRONIC ISSUES: \n# HTN: Cont home medications\n# HLD: Restart home statin at the time of discharge \n# Hypothyroid disease: Cont synthroid\n. \nTRANSITIONAL ISSUES: \n-consider further GI outpatient evaluation', 'medications_prescribed': ['Lovastatin *NF* 40 mg Oral daily', 'lisinopril-hydrochlorothiazide *NF* ___ mg Oral daily', 'Levothyroxine Sodium 100 mcg PO DAILY', 'Cyclobenzaprine ___ mg PO HS:PRN pain', 'Ibuprofen 600 mg PO BID:PRN pain', 'Omeprazole 40 mg PO DAILY', 'RX *omeprazole 40 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0', 'Acetaminophen ___ mg PO Q6H:PRN pain']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 76, 'gender': 'M', 'symptoms': 'slurred speech, weakness, altered mental status', 'medical_history': ['Hypothyroidism', 'Depression'], 'family_history': 'Unable to obtain from pt', 'present_illness': '___ with h/o EtOH abuse requiring hospitalization and \nhypothyroidism, last seen at baseline 24 hrs prior to \npresentation, found by family w/slurred speech, confusion, ?L \nfacial/sided weakness, and confusion in evening. Unknown recent \nillness. EMS noted no e/o pills or trauma at the scene, GCS13, \n___ 186, w/equal movements of all limbs.\n\nIn the ED, initial vitals 97.8F, 121, 148/92, 34, 96% 4LNC. \nPatient was noted to be inattentive and altered, jumping all \nover her bed, intermittently twitching. She received 2x 1 mg \nativan, triggered for agitation, and then given 5 mg haldol. \nNoncon head CT negative for intracranial process but did note \nsinusitis. CXR concerning for patchy consolidation seen \nthroughout R lung esp at base w/volume loss. Got 3L NS, 1 g CTX \nIV, clindamycin 600 mg IV, thiamine 500 mg IV. Labs notable for \nCBC 13.8 (17% bands), BUN 50/Cr 3.2, ALT 116->92, AST 431->334, \nw/otherwise nml LFT, CK 18,900. Osm 311. Serum tox + TCAs. Utox \n+ methadone. VBG ___. Lactate 4.5->1.9. UA showed large \nblood, 100 protein, 1 RBC, 3 WBC. BCX pending. \n\nTox consult noted that benadryl overdose could explain clinical \npicture and +tox screen for TCAs (as well as flexeril, tegretol, \netc). But unlikely to cause renal failure w/AGMA and elevated \nlactate, so need to assess ethylene glycol and consider empiric \nrx w/fomepizole plus PHB protocol. Only use ativan for sedation; \nhaldol is anticholinergic. Suggested potential trial of \nphysostigmine if benefit outweighs risk, monitor EKG, and \nmonitor for withdrawal.\n\nNeurology was consulted and noted R weakness and hyperreflexia \nw/mild R facial droop and ?global aphasia, concerning for L MCA \ninfarct vs small pontine infarct vs toxic-metabolic derangement. \nThey recommended MRI/MRA head/neck, echo, and ASA 325.', 'medications': [{'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.016', 'valuenum': 1.016, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 156.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.9', 'valuenum': 49.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\n=================\nVS: 99.8F, 119 ST, 147/126, 95% 4LNC.\nGen: Confused, intermittently jerking/agitated, no difficulty \nw/breathing\nHEENT: Normocephalic, atraumatic. Grossly EOMI. Pupils 4-5 mm in \nsize and reative to light, atraumatic normocephalic, supple \nneck, mild fullness of submandibulum w/o fluctuance.\nCV: RRR, S1 and S2 heard\nPulm: Clear to auscultation bilaterally, no wheezes or crackles \n(exam limited by snoring)\nAbd: Soft, nontender, nondistended, tympanic throughout, soft \nbowel sounds\nExt: WWP, 2+ ___ bilaterally, 2+ radial pulses, no edema. No \nclonus, ___ reflexes 2+\nSkin: Warm and dry, no rashes or lesions\n\nDISCHARGE EXAM:\n=================\nPHYSICAL EXAM:\nVS - 99 98.0 130-140/80-90s 70-80s 18 94-967% RA\nGeneral: NAD, conversant, A&O x3\nCV: RRR, no m/g/r\nLungs: Crackles bilaterally throughout lung fields', 'diagnoses': [{'icd_code': 'K851', 'desc': 'Biliary acute pancreatitis'}, {'icd_code': 'K8033', 'desc': 'Calculus of bile duct with acute cholangitis with obstruction'}, {'icd_code': 'K8063', 'desc': 'Calculus of gallbladder and bile duct with acute cholecystitis with obstruction'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'K269', 'desc': 'Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation'}, {'icd_code': 'K4030', 'desc': 'Unilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent'}, {'icd_code': 'M109', 'desc': 'Gout, unspecified'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'E806', 'desc': 'Other disorders of bilirubin metabolism'}], 'summary': 'LABS:\n=================\n___ 09:35PM BLOOD WBC-13.8* RBC-5.26 Hgb-16.0 Hct-47.6 \nMCV-90 MCH-30.4 MCHC-33.6 RDW-12.3 Plt ___\n___ 09:35PM BLOOD Neuts-70 Bands-17* Lymphs-8* Monos-4 \nEos-0 Baso-0 Atyps-1* ___ Myelos-0\n___ 09:35PM BLOOD ___ PTT-32.1 ___\n___ 09:35PM BLOOD Glucose-173* UreaN-50* Creat-3.2* Na-141 \nK-4.8 Cl-100 HCO3-17* AnGap-29*\n___ 09:35PM BLOOD ALT-116* AST-431* ___ \nAlkPhos-63 TotBili-1.4\n___ 09:35PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-POS\n___ 10:44PM BLOOD Lactate-4.5*\n___ 11:25PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-POS\n\nSTUDIES:\n================\n___ Non-con CT Head: IMPRESSION: \n1. No acute intracranial abnormalities identified.\n2. Moderate sinus disease.\n___ CXR: IMPRESSION: Patchy regions of consolidation in the \nright lung suspicious for pneumonia.\n___ EEG:\n___ MRI Head w/o con: IMPRESSION: \nThe examination is somewhat degraded by motion artifact. Within \nthese\nlimitations, the only abnormality is detected there are mild \nperiventricular white matter hyper intensity on FLAIR. The \nsuggest chronic small vessel ischemia. There is no evidence of \ninfarction.\n\nDISCHARGE LABS:\n\n___ 06:34AM BLOOD WBC-7.6 RBC-3.88* Hgb-11.9* Hct-36.4 \nMCV-94 MCH-30.6 MCHC-32.6 RDW-12.8 Plt ___\n___ 06:34AM BLOOD Glucose-99 UreaN-9 Creat-0.7 Na-140 K-3.7 \nCl-103 HCO3-29 AnGap-12\n___ 06:34AM BLOOD Glucose-99 UreaN-9 Creat-0.7 Na-140 K-3.7 \nCl-103 HCO3-29 AnGap-12\n___ 06:34AM BLOOD ALT-101* AST-133* ___ \nAlkPhos-84 TotBili-0.5\n___ 06:34AM BLOOD Calcium-8.8 Phos-3.8 Mg-1.___\nMS: Felt to be most likely toxic from either deliberate or \naccidental ingestion of anticholinergic agent given \nmydriasis/dry warm skin/transient hyperthermia to 100.8F/AMS. \nHer elevated CK to ___ can also be explained by muscle \nrigidity from anticholinergic toxicity. Serial EKGs never showed \nQTc prolongation or QRS widening, making TCA ingestion less \nlikely, despite the patient\'s home doxepin. Stroke was ruled out \nwith MRI. Seizure was evaluated by EEG, which was negative. She \nwas briefly intubated for airway protection. Her mental status \nreturned to baseline after about 48 hours. She was transferred \nto the floor and remained stable without further issues with \nmental status.\n\n#Depression: Patient reports history of severe depression \nrequiring 1 prior psychiatric admission. She did intentionally \ndid take multiple medications to "numb her pain" but reports the \nintent was not to kill herself. She was evaluated by psychiatry \non the floor who recommended ___ with psych admission to \ndeac four. She has been on fluoxetine and has planned follow up \nat ___ in ___. \n\n#Pneumonia: Presented with mild leukocytosis and multifocal \nright-sided consolidations. Sputum gram-stain showed gram \npositive cocci. She was initially treated broadly with \nvancomycin and cefepime. She was narrowed to levofloxacin and \nwill complete a 5-day course on ___. Her respiratory status \nremained stable on the floor without need for supplemental O2.\n\n___: likely due to rhabdo (perhaps due to AMS), with prerenal \ncomponent. Cr returned to normal with fluids.\n\n#Transaminitis, likely due to rhabdo (given UA and CK) vs \nhepatic hypoperfusion vs toxic exposure. Coags wnl. LFTs now \ndowntrending.'}}
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{'final_diagnoses': ['overdose', 'depression', 'alcohol abuse'], 'procedures': ['___ Endotracheal Intubation (extubated ___'], 'visit_summary': 'MS: Felt to be most likely toxic from either deliberate or \naccidental ingestion of anticholinergic agent given \nmydriasis/dry warm skin/transient hyperthermia to 100.8F/AMS. \nHer elevated CK to ___ can also be explained by muscle \nrigidity from anticholinergic toxicity. Serial EKGs never showed \nQTc prolongation or QRS widening, making TCA ingestion less \nlikely, despite the patient\'s home doxepin. Stroke was ruled out \nwith MRI. Seizure was evaluated by EEG, which was negative. She \nwas briefly intubated for airway protection. Her mental status \nreturned to baseline after about 48 hours. She was transferred \nto the floor and remained stable without further issues with \nmental status.\n\n#Depression: Patient reports history of severe depression \nrequiring 1 prior psychiatric admission. She did intentionally \ndid take multiple medications to "numb her pain" but reports the \nintent was not to kill herself. She was evaluated by psychiatry \non the floor who recommended ___ with psych admission to \ndeac four. She has been on fluoxetine and has planned follow up \nat ___ in ___. \n\n#Pneumonia: Presented with mild leukocytosis and multifocal \nright-sided consolidations. Sputum gram-stain showed gram \npositive cocci. She was initially treated broadly with \nvancomycin and cefepime. She was narrowed to levofloxacin and \nwill complete a 5-day course on ___. Her respiratory status \nremained stable on the floor without need for supplemental O2.\n\n___: likely due to rhabdo (perhaps due to AMS), with prerenal \ncomponent. Cr returned to normal with fluids.\n\n#Transaminitis, likely due to rhabdo (given UA and CK) vs \nhepatic hypoperfusion vs toxic exposure. Coags wnl. LFTs now \ndowntrending.', 'medications_prescribed': ['Fluoxetine 60 mg PO DAILY', 'Omeprazole 20 mg PO BID', 'Multivitamins 1 TAB PO DAILY', 'Levothyroxine Sodium 50 mcg PO DAILY', 'Levofloxacin 750 mg PO Q24H Duration: 1 Day', 'Thiamine 100 mg PO DAILY', 'FoLIC Acid 1 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'M', 'symptoms': 'altered mental status, inability to ambulate', 'medical_history': ['alcoholism w/ withdrawal seizures', 'schizoaffective', 'tranvestic fetishism', 'personality disorder NOS:', 'bipolar', 'PTSD', 'hyperlidpidemia', 'HTN', 'DM2', 'cocaine abuse, alcohol abuse, benzo abuse, marijuana abuse', 'osteoarthritis of the knee'], 'family_history': 'unknown', 'present_illness': "___ yo M with bipolar vs schizoaffective disorder, suicide \nattempts poly-substance abuse who presented to the ED after \nbeing found on the street intoxicated. Admitted to ___ \nsubstance absue residential program at end of ___ after long \nprevious pysch hospitalization. Left AMA ___. He has been \nfeeling depressed and drinking approximately 2 pints of hard \nalcohol daily for the last month. Minimal food intake during \nthis time. Yesterday drank 3 pints. He does not recall much of \nyesterday before coming to the hospital. He thinks he may have \nfallen but is unsure. He has history of alcohol withdrawal, most \nrecently several months prior at ___. \n In the ED he was seen by psychiatry who felt that he did not \nmeet ___ criteria but should be admitted for ongoing \nobservation. They raised concern for ___'s encephalopathy \ngiven his poor nutrition and apparent altered mental status and \n?inability to ambulate. He was hypernatremic which resolved with \n1 L D5W.", 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'MWF', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [], 'exams': 'VS - 98.5 HR 84 146/80 98% RA\nGeneral/neuro: Appears uncomfortable, anxious. Malodorous.\nAOX3, good knowledge of current events. attempts but is unable \nto complete serial 7s or world backwards. Following all \ncommands. No pronator drift. moving all extremities. EOMI, a few \nbeats of horizontal end gaze nystagmus. PERRLA. tongue midline, \nface symmetric. No tremor. \nHEENT: No tongue fasiculations\nNeck: full ROM OF c-spine. \nCV: RRR, no murmurs. \nLungs: ___. \nAbdomen: soft, slightly distended. Tenderness to palpation in \nleft upper and lower quadrants. No ecchymoses \nExt: wwp, no edema. Some mild tenderness to palpation along \nlower thoracic spine. \n\nDISCAHRGE EXAM\nVS - 97.6 102 139/91 100% RA \nGeneral/neuro: Appears comfortable. AOX3. No nystagmus.\nHEENT: No tongue fasiculations\nNeck: full ROM OF c-spine. \nCV: RRR, no murmurs. \nLungs: ___. \nAbdomen: nontender. \nExt: wwp, no edema.', 'diagnoses': [{'icd_code': '60001', 'desc': 'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)'}, {'icd_code': '5960', 'desc': 'Bladder neck obstruction'}, {'icd_code': '78821', 'desc': 'Incomplete bladder emptying'}, {'icd_code': '78843', 'desc': 'Nocturia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}], 'summary': 'ADMISSION\n___ 08:40PM GLUCOSE-123* UREA N-16 CREAT-1.1 SODIUM-150* \nPOTASSIUM-4.0 CHLORIDE-109* TOTAL CO2-30 ANION GAP-15\n___ 08:40PM estGFR-Using this\n___ 08:40PM ASA-NEG ___ ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 08:40PM WBC-5.4 RBC-4.93 HGB-14.7 HCT-43.8 MCV-89 \nMCH-29.8 MCHC-33.5 RDW-14.5\n___ 08:40PM NEUTS-39.1* LYMPHS-53.5* MONOS-4.4 EOS-2.2 \nBASOS-0.8\n___ 08:40PM PLT COUNT-246\n\nREPORTS:\nIMPRESSION: \nLimited study without evidence of cervical spine injury. If \nthere is continued \nclinical concern for an acute injury, further evaluation should \nbe performed \nwith CT or MRI. \n\nDISCHARGE:\n___ 06:30AM BLOOD WBC-3.7* RBC-4.31* Hgb-13.2* Hct-37.2* \nMCV-86 MCH-30.5 MCHC-35.4* RDW-14.3 Plt ___\n___ 06:30AM BLOOD Glucose-168* UreaN-13 Creat-1.0 Na-142 \nK-3.8 Cl-107 HCO3-24 AnGap-15\n___ 06:30AM BLOOD Calcium-8.8 Phos-4.7* Mg-2.0\n___ 12:27PM BLOOD ALT-33 AST-36 LD(LDH)-276* AlkPhos-56 \nTotBili-0.3\nMr. ___ was admitted to the hospital after being found on the \nstreet intoxicated and reportedly unable to walk. On arrival to \nthe ED, his VS were stable, but labs were notable for \nhypernatremia to 149 and EtOH level of 350. Psychiatry evaluated \nhim in the ED and were concerned for ___-korsakoff syndrome, \nso he was admitted. On the floor, he was not confused and had no \nnystagmus, lowering suspicion for wernicke-korsakoff syndrome. \nHe was maintained on a CIWA scale with Lorazepam initially, and \nwas transitioned to diazepam. Though he received doses of 5 mg \nof Valium for scores of >10 on CIWA, he did not have severe \nwithdrawal symptoms. Labs showed no evidence of alcoholic \nhepatitis and he had no clinical signs of cirrhosis. He received \nhigh dose IV thiamine (500 mg TID) while in the hospital.\n\nOn Hospital Day 1, he felt well, was ambulating well, was \noriented x3, and had no opthalmoplegia. Given that he had neck \npain on admission, flexion and extension films of the c-spine \nwere obtained that ruled out atlanto-axial joint instability.\n\nUnfortunately, on hospital day 2, he eloped from the hospital. \nThis was approximately 72 hours after his last drink, and he \nexhibited no signs of withdrawal prior to elopment.\n\nWhile in the hospital, he mentioned that he had some bright red \nfrom his rectum while having a bowel movement several days \nbefore coming to the hospital. He had no episodes of \nhematochezia while in the hospital. Unfortunately, we were \nunable to arrange further follow up for this. His hemoglobin \nremained stable at his baseline during this admission.\n\nAfter the patient eloped, security was contacted and they \nconducted a search of the hospital. The patient was not able to \nbe found. We attempted contacting the patient using his cell \nphone number, and two residential phone numbers listed in his ___ \nchart; these attempts were also unsuccessful.'}}
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{'final_diagnoses': ['alcohol intoxication', 'substance abuse disorder', 'bipolar disorder', 'schizoaffective disorder'], 'procedures': ['none'], 'visit_summary': 'Mr. ___ was admitted to the hospital after being found on the \nstreet intoxicated and reportedly unable to walk. On arrival to \nthe ED, his VS were stable, but labs were notable for \nhypernatremia to 149 and EtOH level of 350. Psychiatry evaluated \nhim in the ED and were concerned for ___-korsakoff syndrome, \nso he was admitted. On the floor, he was not confused and had no \nnystagmus, lowering suspicion for wernicke-korsakoff syndrome. \nHe was maintained on a CIWA scale with Lorazepam initially, and \nwas transitioned to diazepam. Though he received doses of 5 mg \nof Valium for scores of >10 on CIWA, he did not have severe \nwithdrawal symptoms. Labs showed no evidence of alcoholic \nhepatitis and he had no clinical signs of cirrhosis. He received \nhigh dose IV thiamine (500 mg TID) while in the hospital.\n\nOn Hospital Day 1, he felt well, was ambulating well, was \noriented x3, and had no opthalmoplegia. Given that he had neck \npain on admission, flexion and extension films of the c-spine \nwere obtained that ruled out atlanto-axial joint instability.\n\nUnfortunately, on hospital day 2, he eloped from the hospital. \nThis was approximately 72 hours after his last drink, and he \nexhibited no signs of withdrawal prior to elopment.\n\nWhile in the hospital, he mentioned that he had some bright red \nfrom his rectum while having a bowel movement several days \nbefore coming to the hospital. He had no episodes of \nhematochezia while in the hospital. Unfortunately, we were \nunable to arrange further follow up for this. His hemoglobin \nremained stable at his baseline during this admission.\n\nAfter the patient eloped, security was contacted and they \nconducted a search of the hospital. The patient was not able to \nbe found. We attempted contacting the patient using his cell \nphone number, and two residential phone numbers listed in his ___ \nchart; these attempts were also unsuccessful.', 'medications_prescribed': ['Cyanocobalamin 1000 mcg PO DAILY', 'FoLIC Acid 1 mg PO DAILY', 'Magnesium Oxide 400 mg PO DAILY', 'Prazosin 6 mg PO QHS', 'Topiramate (Topamax) 25 mg PO BID', 'ZIPRASidone Hydrochloride 60 mg PO BID', 'Acamprosate 666 mg PO TID', 'Ibuprofen 600 mg PO Q6H:PRN pain', 'Thiamine 100 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 72, 'gender': 'M', 'symptoms': 'Palpitaions', 'medical_history': ['Aortic stenosis', 'Atrial fibrillation', 'Asthma', 'Sleep Apnea (Uses CPAP)', 'Hyperlipidemia', 'Umbilical Hernia', 'Degenerative joint disease', 'Arthritis', 'Rheumatic fever', 'Inferior wall myocardial infarction', 'Hypertension', 'Anemia', 'Mitral valve prolapse', 'S/P Roux-en-y gastric bypass', 'Bilateral knee replacements ___'], 'family_history': 'Notable only for cancer', 'present_illness': '___ year old female with atrial fibrillation and aortic valve \nstenosis followed by serial echocardiograms. Her most recent \nechocardigram revealed severe\naortic stenosis with significant gradients. Given the \nprogression of her disease, she has been referred for surgical \nevaluation. She admits today after preoperative catherization \nfor heparin bridge with plans for AVR/? MAZE in am', 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.9, . Estimated GFR = 35 if non African-American (mL/min/1.73 m2) . Estimated GFR = 42 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '373', 'valuenum': 373.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13279.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 852.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58.3', 'valuenum': 58.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 57.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.04', 'valuenum': 1.04, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.8', 'valuenum': 49.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.13', 'valuenum': 0.13, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.43', 'valuenum': 0.43, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.64', 'valuenum': 1.64, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '59.7', 'valuenum': 59.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '50', 'valuenum': 50.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '338', 'valuenum': 338.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 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'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60.7', 'valuenum': 60.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '62.0', 'valuenum': 62.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '54', 'valuenum': 54.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60.0', 'valuenum': 60.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse:68 Resp:18 O2 sat: 97% RA\nB/P Right:104/48 Left: \nHeight:5\'5" Weight:250 #\n\nGeneral:\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] EOMI [x]\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [] Irregular [x] Murmur ___ SEM\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds\n+ [x]\nobese, well healed midline abdominal scar with umbilical hernia\nat top of scar\nExtremities: Warm [x], well-perfused [x] Edema: no \nVaricosities:\nmild, bilat\nNeuro: Grossly intact, non-focal exam\nPulses:\nFemoral Right: 1+ Left: 1+ - no hematoma\nDP Right: 2+ Left: 2+\n___ Right: 1+ Left: 1+\nRadial Right: 2+ Left: 2+', 'diagnoses': [{'icd_code': 'I5023', 'desc': 'Acute on chronic systolic (congestive) heart failure'}, {'icd_code': 'E43', 'desc': 'Unspecified severe protein-calorie malnutrition'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'E854', 'desc': 'Organ-limited amyloidosis'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'I428', 'desc': 'Other cardiomyopathies'}, {'icd_code': 'I361', 'desc': 'Nonrheumatic tricuspid (valve) insufficiency'}, {'icd_code': 'I340', 'desc': 'Nonrheumatic mitral (valve) insufficiency'}, {'icd_code': 'I43', 'desc': 'Cardiomyopathy in diseases classified elsewhere'}, {'icd_code': 'I130', 'desc': 'Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'Z6825', 'desc': 'Body mass index [BMI] 25.0-25.9, adult'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'M4806', 'desc': 'Spinal stenosis, lumbar region'}, {'icd_code': 'I4430', 'desc': 'Unspecified atrioventricular block'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'Z950', 'desc': 'Presence of cardiac pacemaker'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}], 'summary': '___ 05:15AM BLOOD WBC-8.5 RBC-3.27* Hgb-8.9* Hct-27.5* \nMCV-84 MCH-27.2 MCHC-32.4 RDW-15.3 Plt ___\n___ 11:30AM BLOOD WBC-5.3 RBC-3.77* Hgb-10.1* Hct-31.6* \nMCV-84 MCH-26.8* MCHC-32.0 RDW-14.9 Plt ___\n___ 11:30AM BLOOD ___ PTT-26.7 ___\n___ 05:35AM BLOOD ___\n___ 05:05AM BLOOD Glucose-102* UreaN-30* Creat-0.9 Na-142 \nK-4.4 Cl-103 HCO3-33* AnGap-10\n___ 11:30AM BLOOD Glucose-90 UreaN-21* Creat-0.6 Na-144 \nK-3.9 Cl-110* HCO3-28 AnGap-10\n___ 11:30AM BLOOD ALT-9 AST-12 AlkPhos-72 Amylase-42 \nTotBili-0.3\n___ 05:05AM BLOOD Mg-1.9\n___ 11:30AM BLOOD VitB12-246\n___ 11:30AM BLOOD %HbA1c-5.6 eAG-114\n___ 11:30AM BLOOD Triglyc-42 HDL-63 CHOL/HD-2.1 LDLcalc-61\nAdmitted after cardiac catheterization and underwent \npreoperative workup. Next day was brought to the operating room \nfor aortic valve replacement. See operative report for further \ndetails. She received vancomycin for perioperative antibiotics. \n Post operatively she was transferred to the intensive care unit \nfor management. In the first ___ hours she was weaned \nfrom sedation, awoke and was extubated without complications. \nOn post operative day two she was transferred to the floor. \nPhysical therapy worked with her on strength and mobility. She \nwas started on anticoagulation for her mechanical aortic valve \nand atrial fibrillation. She continued to do well and was ready \nfor discharge home with services on post operative day six.'}}
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{'final_diagnoses': ['Aortic stenosis s/p AVR', 'Atrial fibrillation', 'Asthma', 'Sleep Apnea on CPAP', 'Hyperlipidemia', 'Umbilical Hernia', 'Degenerative joint disease', 'Arthritis', 'Rheumatic fever', 'Inferior wall myocardial infarction', 'Hypertension', 'Anemia', 'Mitral valve prolapse'], 'procedures': ['Cardiac catheterization', 'Aortic valve replacement, 23 mm valve'], 'visit_summary': 'Admitted after cardiac catheterization and underwent \npreoperative workup. Next day was brought to the operating room \nfor aortic valve replacement. See operative report for further \ndetails. She received vancomycin for perioperative antibiotics. \n Post operatively she was transferred to the intensive care unit \nfor management. In the first ___ hours she was weaned \nfrom sedation, awoke and was extubated without complications. \nOn post operative day two she was transferred to the floor. \nPhysical therapy worked with her on strength and mobility. She \nwas started on anticoagulation for her mechanical aortic valve \nand atrial fibrillation. She continued to do well and was ready \nfor discharge home with services on post operative day six.', 'medications_prescribed': ['Torsemide 20 mg Tablet Sig: Two (2) Tablet PO twice a day: \nplease take twice a day for 7 days then decrease to once a day .\nDisp:*74 Tablet(s)* Refills:*0*', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*0*', 'Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3H as \nneeded for pain.\nDisp:*60 Tablet(s)* Refills:*0*', 'Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day).\nDisp:*60 Disk with Device(s)* Refills:*0*', 'Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*', 'Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as \nneeded for sleep. ', 'Claritin 10 mg Tablet Sig: One (1) Tablet PO once a day. ', 'Magnesium Oxide 500 mg Tablet Sig: One (1) Tablet PO once a \nday.\nDisp:*30 Tablet(s)* Refills:*0*', 'Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*0*', 'Tricor 145 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*0*', 'Combivent ___ mcg/Actuation Aerosol Sig: Two (2) \nInhalation four times a day.\nDisp:*qs qs* Refills:*0*', 'Beclomethasone Dipropionate 40 mcg/Actuation Aerosol Sig: \nOne (1) Inhalation twice a day.\nDisp:*qs qs* Refills:*0*', 'Effexor XR 150 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO once a day.\nDisp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*', 'Lamictal 150 mg Tablet Sig: Two (2) Tablet PO once a day.\nDisp:*60 Tablet(s)* Refills:*0*', 'Wellbutrin SR 200 mg Tablet Sustained Release Sig: One (1) \nTablet Sustained Release PO twice a day.\nDisp:*60 Tablet Sustained Release(s)* Refills:*0*', 'Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a \nday for 1 months.\nDisp:*30 Tablet(s)* Refills:*0*', 'Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).\nDisp:*60 Tablet(s)* Refills:*0*', 'Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*0*', 'Warfarin 5 mg Tablet Sig: Goal INR 2.5-3.0 Tablets PO once a \nday: dose to be adjusted by ___ clinic \n.\nDisp:*60 Tablet(s)* Refills:*2*', 'Warfarin 2 mg Tablet Sig: Goal INR 2.5-3.0 Tablets PO once a \nday: dose to be adjusted by ___ clinic .\nDisp:*60 Tablet(s)* Refills:*2*', 'Coumadin \nYou will have INR drawn ___ for further dosing of coumadin \n- you will receive your coumadin dose for ___ prior to leaving', 'Outpatient Lab Work\nLabs: ___ for Coumadin \x96 indication Mechanical AVR \nGoal INR 2.5-3.0\nFirst draw ___\nResults to ___ - Dr ___ \nphone ___ fax ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'F', 'symptoms': 'Shortness of Breath', 'medical_history': ["1. CHF with EF of 10% s/p BiV pacer on coumadin, recently \nadmitted for CHF exacerbation in ___. ESRD - on HD since last admit (D/C'd ___", '3. CAD s/p MI & CABG x 2 ___ and revised in ___', '4. DMII x ___ on insulin', '5. s/p L BKA', '6. Hypothyroidism', '7. ? a-fib'], 'family_history': 'Family History:\nnon-contributory\n.', 'present_illness': 'Ms. ___ is a ___ y/o woman with CHF (___), DM2, CAD s/p \nMI and CABGx2, ESRD on HD who presented to her PCP 7 days after \nd/c from Hospital. Her PCP stated that her SOB was concerning \nenough to send her to the ED. Patient was recently hospitalized \nfor volume overload eventually requiring HD. She was recently \nset up at ___ dialysis for ___ HD. She states she \ndid not miss an appointment but became progressively SOB and had \nincreased edema since ___ after dialysis.\nIn ED, Patient had CXR concerning for volume overload, and \nhyperkalemia (5.9) with hyponatremia (130) which prompted Renal \nto dialyze her this ___\n .', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ertapenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ertapenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ertapenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71.0', 'valuenum': 71.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '516', 'valuenum': 516.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.24', 'valuenum': 4.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.002', 'valuenum': 1.002, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '___', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREENTOP.'}, {'value': '___', 'valuenum': 32.6, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': '___', 'valuenum': 18.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77.3', 'valuenum': 77.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '364', 'valuenum': 364.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: 98 101/55 79 18 100% RA\nGen: NAD, AOx3\nHEENT: Sclera anicteric. PERRL, EOMI. \nNeck: No LAD\nCV: quiet heart sounds, II/VI holosys murmur at LSB, soft S3 \nChest: Distant breath sounds, some end expiratory wheezes. No \ncrackles or rhonchi.\nAbd: Soft, NT/ND, obese. \nExt: L AKA stump well healed with mild tenderness at baseline, \nRLE with ___ edema at ankle, +DP \nSkin: RLE with healing posterior calf ulcer, minimal erythema, \ndry and intact', 'diagnoses': [{'icd_code': '72293', 'desc': 'Other and unspecified disc disorder, lumbar region'}, {'icd_code': '73008', 'desc': 'Acute osteomyelitis, other specified sites'}, {'icd_code': '04184', 'desc': 'Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes'}, {'icd_code': '78830', 'desc': 'Urinary incontinence, unspecified'}], 'summary': "WBC 8.5 \nHgb 8.9 \nHct 28.9 \nPlt 162 \n.\nSPECIMEN GROSSLY HEMOLYZED\n130 | 91 | 39 \n---------------<135\n6.9 | 31 | 3.4 \n.\nTrop (0.35 on ___- 0.96 -> 0.98 -> 0.87\nCKMB (7 on ___- 9 -> 8\n#) SOB: Patient was dialyzed 2L prior to admit to floor. Her \nSOB was much improved and she did not complain of chest pain or \ntightness. During her Hospital course, the did not desat and \nwas successfully weans off of O2. At night, the patient's SOB \nwas relieved by ipratroprium and albuterol Nebulizers, and \nwheezing was much improved on day of dicharge. She was advised \nto limit fluid intake to 1L per day and keep her appointments \nfor dialysis. Given albuterol nebs for wheezing.\n\n#) CHF: Patient with multiple admissions for CHF exacerbation. \nShe was successfully dialized with releif of symptoms after \ndialysis. \n-She was continued on her home dose of carvedilol.\n-Due to lower pressures (~100/50) after dialysis her hydralizine \nand Imdur were d/c'd.\n-Lisinopril was started at 5 mg qday and continued at discharge.\n\n#) Elevated Cardiac markers: On admit, the patient had troponins \nelevated above prior admit (___) but trended down \n(->0.98->0.87) and CKMB was normal and stable. ECG showed BiV \npacing but without acute changes from prior ECG.\n- Most likely etiology was demand ischemia superimposed on ESRD. \nNSTEMI very unlikely with no MB changes and Trops trending down. \n\nPatient was discharged on CHF meds as listed above\n\n#) ESRD on HD: Patient received HD x2 while in house and \nelectrolytes were with normal limits on discharge.\n-Continued sevelimer and advised patient to return to her \noutpatient HD schedule (___\n\n#) A-fib with BiV pacing: Patient was not therapeutic on \ncoumadin but was continued at 3mg per day.\n-monitor ___ during dialysis labs.\n\n#) Hyperlipidemia: No issues. Continue lipitor\n\n#) DM2: No issues. continue outpatient doses of glargine and \nISS.\n\n#) Hypothyroidism: No issues. Continue levothyroxine. F/U with \nendocrinologist in ___\n\n#) Code: Patient was Full Code while in house."}}
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{'final_diagnoses': ['Acute on chronic systolic heart failure', 'Hyperkalemia', 'Nonthrombotic troponin elevation', 'Ischemic CMP, EF 10% s/p ICD-BiV pacer', 'Atrial fibrillation', 'CKD stage V on hemodialysis', 'CABG x 2', 'Diabetes mellitus type II', 'Hypothyroidism', 'Asthma', 's/p left BKA'], 'procedures': ['none'], 'visit_summary': "#) SOB: Patient was dialyzed 2L prior to admit to floor. Her \nSOB was much improved and she did not complain of chest pain or \ntightness. During her Hospital course, the did not desat and \nwas successfully weans off of O2. At night, the patient's SOB \nwas relieved by ipratroprium and albuterol Nebulizers, and \nwheezing was much improved on day of dicharge. She was advised \nto limit fluid intake to 1L per day and keep her appointments \nfor dialysis. Given albuterol nebs for wheezing.\n\n#) CHF: Patient with multiple admissions for CHF exacerbation. \nShe was successfully dialized with releif of symptoms after \ndialysis. \n-She was continued on her home dose of carvedilol.\n-Due to lower pressures (~100/50) after dialysis her hydralizine \nand Imdur were d/c'd.\n-Lisinopril was started at 5 mg qday and continued at discharge.\n\n#) Elevated Cardiac markers: On admit, the patient had troponins \nelevated above prior admit (___) but trended down \n(->0.98->0.87) and CKMB was normal and stable. ECG showed BiV \npacing but without acute changes from prior ECG.\n- Most likely etiology was demand ischemia superimposed on ESRD. \nNSTEMI very unlikely with no MB changes and Trops trending down. \n\nPatient was discharged on CHF meds as listed above\n\n#) ESRD on HD: Patient received HD x2 while in house and \nelectrolytes were with normal limits on discharge.\n-Continued sevelimer and advised patient to return to her \noutpatient HD schedule (___\n\n#) A-fib with BiV pacing: Patient was not therapeutic on \ncoumadin but was continued at 3mg per day.\n-monitor ___ during dialysis labs.\n\n#) Hyperlipidemia: No issues. Continue lipitor\n\n#) DM2: No issues. continue outpatient doses of glargine and \nISS.\n\n#) Hypothyroidism: No issues. Continue levothyroxine. F/U with \nendocrinologist in ___\n\n#) Code: Patient was Full Code while in house.", 'medications_prescribed': ['1. Atorvastatin 80 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).', '2. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H. PRN as \nneeded for pain.\nDisp:*20 Tablet(s)* Refills:*0*', '3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '4. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO qhs prn as needed \nfor sleep.\nDisp:*30 Tablet(s)* Refills:*0*', '5. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO qhs prn as \nneeded for anxiety.\nDisp:*20 Tablet(s)* Refills:*0*', '6. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', '8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', '10. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO Once Daily at \n4 ___. ', '11. Sevelamer HCl 400 mg Tablet Sig: One (1) Tablet PO TID \nW/MEALS (3 TIMES A DAY WITH MEALS).', '12. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) inh Inhalation q4h prn as needed for \nSOB.', '13. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).', '14. Insulin Glargine 100 unit/mL Solution Sig: Twelve (12) units \nSubcutaneous at bedtime.', '15. Insulin Lispro 100 unit/mL Insulin Pen Sig: One (1) \ninjection Subcutaneous three times a day: please adminster \nsubcutaneously \nup to three times daily as needed per sliding scale.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'hyperkalemia', 'medical_history': ['Diabetes mellitus type 2 insulin complicated by peripheral \nneuropathy and nephropathy', 'Cervical and lumbar degenerative joint disease for the past ___ \nyears secondary to trauma.', 'Hypertension', 'Left calcaneal osteomyelitis s/p OR debridement on ___ \nfollowed by 8w CTX/Flagyl and then levofloxacin x 2w; Cultures \nfrom OR specimens subsequently grew Strep viridans, Proteus \nvulgaris and Prevotella species. Had previously been in total \ncontact cast but now just wrapped with ACE bandages'], 'family_history': 'No history of DM, Heart disease, HLD, HTN.', 'present_illness': 'HPI: This is a \n___ gentleman with DMII, neuropathy,hx L calcaneal \nosteomyelitis, \nchronic bilateral heal ulcers with right hallux amputation, \nrecently discharged ___ on vancomycin and ertapenem for \npresumed osteomyelitis for planned 6 weeks course. He \nparticipates in ID OPAT, and on evaluation by Dr ___ \n___ he was noted to be hyperkalemic to 5.8 ,with \nconcommitant LFT elevation and ___ and was instructed to come in \nto the ED. \n\nOn arrival to the ED, initial vitals were:\nHe did not have any chest pain and EKG showed some peaked T \nwaves. He recieved kayexalate 30mg and was admitted to the \nfloor. \n \nCurrently, he continues to deny chest pain.', 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nystatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.024', 'valuenum': 1.024, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.8, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 148.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, 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'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 193.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '214', 'valuenum': 214.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\nVS - Temp : 98.2 BP: 167/68 HR:62 R:18 O2-sat 100 % RA \nGeneral:comfortable, AOX3 \nHEENT: nc, AT, opc, perrla \nNeck: no lymphadenopathy, JVP 7cm \nCV: RRR, II/VI systolic murmur \nLungs: CTA-B \nAbdomen: +ve bs, soft, nt, nd, no masses \nGU: no foley\nExt: s/p right hallux amputation, 2+ peripheral pulses \nbilaterally, 3+ pitting edema to knees right lower extremity, 3+ \n\npitting edema to knees left lower extremity, no tenderness. \nclean based ulcer left heel with surrounding maceration. Probe \ndeferred per pt request. Similar ulcer right dorsal heel with \nsutures in place. Small talon noir left second toe. No \nperipheral sensation in feet on examination. \nGait: deferred \n\nDISCHARGE EXAM\nVS: 98.1 143/78 63 18 98%\nGEN: comfortable in NAD\nHEENT: sclera anicteric, MMM\nCV: RRR, ___ systolic murmur\nRESP: CTAB\nABD: +BS, nontender, nondistended\nEXT: dressing c/d/i. \nlabs: see below', 'diagnoses': [{'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '27739', 'desc': 'Other amyloidosis'}, {'icd_code': '7843', 'desc': 'Aphasia'}, {'icd_code': '34290', 'desc': 'Hemiplegia, unspecified, affecting unspecified side'}, {'icd_code': '1120', 'desc': 'Candidiasis of mouth'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V103'}, {'icd_code': '78451', 'desc': 'Dysarthria'}, {'icd_code': '29420', 'desc': 'Dementia, unspecified, without behavioral disturbance'}, {'icd_code': '4379', 'desc': 'Unspecified cerebrovascular disease'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '79092', 'desc': 'Abnormal coagulation profile'}, {'icd_code': '78194', 'desc': 'Facial weakness'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'V4987', 'desc': 'Physical restraints status'}], 'summary': 'Admission Labs:\n___ 04:58PM LACTATE-1.0\n___ 04:45PM GLUCOSE-225* UREA N-35* CREAT-1.8* \nSODIUM-132* POTASSIUM-6.2* CHLORIDE-106 TOTAL CO2-16* ANION \nGAP-16\n___ 04:45PM ALT(SGPT)-131* AST(SGOT)-89* ALK PHOS-218* \nTOT BILI-0.1\n___ 04:45PM ALBUMIN-3.7\n___ 04:45PM WBC-8.5 RBC-2.74* HGB-7.4* HCT-24.1* MCV-88 \nMCH-27.1 MCHC-30.9* RDW-15.7*\n___ 04:45PM NEUTS-70.7* LYMPHS-13.1* MONOS-8.7 EOS-6.8* \nBASOS-0.7\n___ 04:45PM PLT COUNT-207\n___ 04:45PM ___ PTT-36.7* ___\n.\n\nCXR: ___\nTip of PIC is somewhat difficult to visualize due to removal of\nindwelling guidewire, and the catheter is not clearly visualized \nbeyond the junction of the left brachiocephalic vein and \nsuperior vena cava. An oblique oriented radiograph may be \nhelpful to confirm positioning. Otherwise unchanged appearance \nof the chest since a recent study of ___\n.\n__________________________________________________________\n___ 4:15 pm URINE Source: ___. \n\n URINE CULTURE (Pending): \n__________________________________________________________\n___ 8:35 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 8:00 am BLOOD CULTURE Source: Line-picc line. \n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 4:50 pm BLOOD CULTURE #2 SOURCE: VENIPUNCTURE. \n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 4:45 pm BLOOD CULTURE SOURCE: LINE-PICC #1. \n\n Blood Culture, Routine (Pending): \n\nDISCHARGE LABS\n\n___ 05:49AM BLOOD WBC-7.0 RBC-2.58* Hgb-7.1* Hct-22.3* \nMCV-86 MCH-27.3 MCHC-31.6 RDW-15.3 Plt ___\n___ 05:49AM BLOOD Glucose-152* UreaN-34* Creat-2.1* Na-134 \nK-5.3* Cl-102 HCO3-25 AnGap-12\n___ 05:48AM BLOOD ALT-64* AST-28 AlkPhos-177* TotBili-0.2\n___ 05:49AM BLOOD Calcium-8.8 Phos-3.9 Mg-1.9\n\nPERTINENT STUDIES\n___ 04:15PM URINE Blood-MOD Nitrite-NEG Protein-100 \nGlucose-70 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 04:15PM URINE Color-Straw Appear-Clear Sp ___\n___ 04:15PM URINE RBC-14* WBC-1 Bacteri-NONE Yeast-NONE \nEpi-0\n___ 03:41PM URINE Hours-RANDOM UreaN-250 Creat-31 Na-111 \nK-16 Cl-114\n___ 03:41PM URINE Osmolal-357\n___ 07:46AM BLOOD Cortsol-14.0\n___ 01:18AM BLOOD Vanco-15.___ gentleman with DMII, neuropathy,hx L calcaneal \nosteomyelitis, \nchronic bilateral heal ulcers with right hallux amputation, \nrecently discharged ___ on vancomycin and ertapenem for \npresumed osteomyelitis for planned 6 weeks course presenting \nwith hyperkalemia.\nACUTE CARE\n# Hyperkalemia: initially thought to be secondary to ertapenem. \nNo EKG changes, asympyomatic. With kayexalate potassium \nimproved. However, despite being on meropenem and ultimately \ndiscontinuing this medication, his potassium again became \nelevated and was associated with peaked T waves. He received \nlasix, kayexelate and refused extra insulin due to concern for \nhypoglycemia which he has experienced in the past. The etiology \nfor his hyperkalemia is unclear. Urine lytes were normal. His \nblood pressure was normotensive, so adrenal insuffiency was felt \nto be very unlikely, and an AM cortisol revealed: 14. The \npatient was not on other medications which are associated with \nhyperkalemia. Further, his renal failure was not particularly \nelevated and actually improved despite worsening potassium which \nargues against renal failure being the etiology of his \nhyperkalemia, however, ultimately, this is the most likely \nexplanation. He was discharged with potassium of 5.3 because \nreview of ___ and ___ records revealed a chronically elevated \npotassium at this level, which is reassuring that it is not new \nand has been well tolerated, but is concerning and should prompt \nfurther evaluation.\n.\n#LFT elevation: mild, likely secondary to antibiotics. Pt denied \nabdominal pain, nause. LFTs trended down, but can be trended as \nan outpatient.\n.\n#Osteomyelitis: on vancomycin/ertapenem for planned 6 week \ncourse planned to complete ___. Foot ulcers clean based, no \ndrainage, warmth or tenderness. PICC in place for IV abx c/d/i. \nHe will f/u with podiatrisy ___ days post discharge. He \ncompleted the meropenem course on ___ per ID. They wanted him \nto have vancomycin until ___, so this was arranged.\n.\n# Hyponatremia: 132 on admission. Likely hypervolemmic \nhypernatremia with BLE edema evident.\n\nCHRONIC CARE\n#. Venous insufficiency: BLE swelling, no evidence pulmonary \nedema, no hx CHF. \n___ edema managed with ace wrapping, elevation and continued p.o \nlasix. \n\n#Anemia: Prior labs indicate likely mixed picture of iron \ndeficiency and anemia of chronic disease. Repeatedly refused \ncolonoscopy. HCT was as low as 21.9 but patient refused \ntransfusion or colonoscopy. Please trend as outpatient.\n \n#Chronic kidney disease: Baseline Cr of around 1.9. Cr 1.6 on \n___, prior to receiving extra lasix for hyperkalemia, 1.8 on \nadmission. \n \n#Diabetes mellitus, type 2: Uncontrolled diabetes with HbA1c \n8.8%. Continued NPH 10U glargine in the AM and 6U glargine in \nthe ___.'}}
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{'final_diagnoses': ['Osteomyelitis', 'Hyperkalemia'], 'procedures': ['none'], 'visit_summary': 'ACUTE CARE\n# Hyperkalemia: initially thought to be secondary to ertapenem. \nNo EKG changes, asympyomatic. With kayexalate potassium \nimproved. However, despite being on meropenem and ultimately \ndiscontinuing this medication, his potassium again became \nelevated and was associated with peaked T waves. He received \nlasix, kayexelate and refused extra insulin due to concern for \nhypoglycemia which he has experienced in the past. The etiology \nfor his hyperkalemia is unclear. Urine lytes were normal. His \nblood pressure was normotensive, so adrenal insuffiency was felt \nto be very unlikely, and an AM cortisol revealed: 14. The \npatient was not on other medications which are associated with \nhyperkalemia. Further, his renal failure was not particularly \nelevated and actually improved despite worsening potassium which \nargues against renal failure being the etiology of his \nhyperkalemia, however, ultimately, this is the most likely \nexplanation. He was discharged with potassium of 5.3 because \nreview of ___ and ___ records revealed a chronically elevated \npotassium at this level, which is reassuring that it is not new \nand has been well tolerated, but is concerning and should prompt \nfurther evaluation.\n.\n#LFT elevation: mild, likely secondary to antibiotics. Pt denied \nabdominal pain, nause. LFTs trended down, but can be trended as \nan outpatient.\n.\n#Osteomyelitis: on vancomycin/ertapenem for planned 6 week \ncourse planned to complete ___. Foot ulcers clean based, no \ndrainage, warmth or tenderness. PICC in place for IV abx c/d/i. \nHe will f/u with podiatrisy ___ days post discharge. He \ncompleted the meropenem course on ___ per ID. They wanted him \nto have vancomycin until ___, so this was arranged.\n.\n# Hyponatremia: 132 on admission. Likely hypervolemmic \nhypernatremia with BLE edema evident.\n\nCHRONIC CARE\n#. Venous insufficiency: BLE swelling, no evidence pulmonary \nedema, no hx CHF. \n___ edema managed with ace wrapping, elevation and continued p.o \nlasix. \n\n#Anemia: Prior labs indicate likely mixed picture of iron \ndeficiency and anemia of chronic disease. Repeatedly refused \ncolonoscopy. HCT was as low as 21.9 but patient refused \ntransfusion or colonoscopy. Please trend as outpatient.\n \n#Chronic kidney disease: Baseline Cr of around 1.9. Cr 1.6 on \n___, prior to receiving extra lasix for hyperkalemia, 1.8 on \nadmission. \n \n#Diabetes mellitus, type 2: Uncontrolled diabetes with HbA1c \n8.8%. Continued NPH 10U glargine in the AM and 6U glargine in \nthe ___.', 'medications_prescribed': ['Furosemide 20 mg PO DAILY', 'Levothyroxine Sodium 125 mcg PO DAILY', 'Metoprolol Tartrate 25 mg PO BID', 'Multivitamins 1 TAB PO DAILY', 'Vancomycin 750 mg IV Q 24H \nRX *vancomycin 750 mg 750 mg IV daily Disp #*6 Bag Refills:*0', 'Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush', 'NPH 10 Units Breakfast\nNPH 6 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'Outpatient Lab Work\nPlease check chemistry and fax results to ___. \nPhone: ___ \nFax: ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 68, 'gender': 'M', 'symptoms': 'Hyperglycemia\nSyncope', 'medical_history': ['Insulin dependent DM, diagnosed one year ago, was told type 1', 'chronic pancreatitis', 'HTN', 'HLD', 'H/O recurrent pneumonia', 'Multiple stab wounds ___ Right upper thorax, left axilla area & \nmid-lower back'], 'family_history': 'Notable for diabetes in father (type 1), mother (type 2), \nbrother (type 2), and grandfather. Reports', 'present_illness': "___ yo M with T1DM and chronic pancreatitis who presents from \nhome for syncope, head strike, and elevated blood sugars.\n\nPatient had a recent admission ___ for DKA thought ___ \ndietary indiscretion and insulin noncompliance. He was seen by \n___ and discharged on lantus 30 units bid and sliding scale \nHumalog. He was also started on amitriptyline and gabapentin \nfor chronic pain. He then established care with PCP and was \nreferred to the pain clinic (no visit yet).\n\nHe presented to ED ___ after he fell while getting out of the \nshower. He states that for a few days he has had a slight \nincrease in his baseline abdominal pain with subsequent lack of \nappetite. Has not eaten much for the past few days. While \nshowering he felt lightheaded. Stepped out and then next thing \nhe knew he was on the floor looking at the ceiling. + head \nstrike and LOC. No preceding palpitations. Thinks he felt some \nslight chest pain but unsure. \n\nWent to the ED where sugars were in 400s with gap. VBG did not \nshow acidosis. 10 ketones in urine. He was given IVF and SQ \ninsulin and admitted.\n\nNightfloat put him on prior ___ regimen. He did require \nsignificant amounts of Humalog overnight for persistently \nelevated sugars. This morning he was then hypoglycemic to the \n20's. Given dextrose with improvement to ___.", 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NORepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NEB', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cholestyramine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 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'valuenum': 500.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '498', 'valuenum': 498.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.45', 'valuenum': 2.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63.7', 'valuenum': 63.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.51', 'valuenum': 2.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.7', 'valuenum': 63.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 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'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.18', 'valuenum': 2.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60.6', 'valuenum': 60.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.7', 'valuenum': 22.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.18', 'valuenum': 1.18, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71.2', 'valuenum': 71.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.82', 'valuenum': 1.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.28', 'valuenum': 0.28, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.24', 'valuenum': 1.24, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.99', 'valuenum': 6.99, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '63.2', 'valuenum': 63.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': '<5.'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '269', 'valuenum': 269.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15072.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 229.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-5', 'valuenum': -5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 6.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERFIED.'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.30', 'valuenum': 0.3, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.7', 'valuenum': 21.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85.5', 'valuenum': 85.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.10', 'valuenum': 2.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.78', 'valuenum': 0.78, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.01', 'valuenum': 7.01, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '58.8', 'valuenum': 58.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<20.'}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '247', 'valuenum': 247.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Desirable pH greater than 6.5. Interpret results accordingly.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '213', 'valuenum': 213.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hazy*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.43', 'valuenum': 2.43, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63.0', 'valuenum': 63.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.31', 'valuenum': 2.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.6', 'valuenum': 63.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '502', 'valuenum': 502.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<5.'}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.0, . estimated GFR (eGFR) is likely between 33 and 40 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.32', 'valuenum': 2.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65.5', 'valuenum': 65.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<5.'}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '217', 'valuenum': 217.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '513', 'valuenum': 513.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, 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'___', 'valuenum': 1.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '244', 'valuenum': 244.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.68', 'valuenum': 2.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '64.8', 'valuenum': 64.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.39', 'valuenum': 2.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63.9', 'valuenum': 63.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2, . estimated GFR (eGFR) is likely between 60 and 72 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '237', 'valuenum': 237.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.67', 'valuenum': 2.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66.2', 'valuenum': 66.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '214', 'valuenum': 214.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.51', 'valuenum': 2.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65.3', 'valuenum': 65.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, 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'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.57', 'valuenum': 2.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65.4', 'valuenum': 65.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.3', 'valuenum': 24.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '245', 'valuenum': 245.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.56', 'valuenum': 2.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64.3', 'valuenum': 64.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '232', 'valuenum': 232.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.64', 'valuenum': 2.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64.4', 'valuenum': 64.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.0', 'valuenum': 22.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.55', 'valuenum': 2.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.9', 'valuenum': 63.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.7, . estimated GFR (eGFR) is likely between 40 and 48 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.5', 'valuenum': 21.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\n Vitals: 98.5 PO 133 / 80 L Lying ___ RA \n General: Alert, oriented, no acute distress \n HEENT: Sclera anicteric, MMM, oropharynx clear, neck supple, \nJVP not elevated, no LAD, normocepahlic atraumatic \n Lungs: Rales heard throughout with minimal wheezing \n Abdomen: soft, NABS, very tender throughout with guarding, no \nrebound \n Ext: Warm, well perfused, no cyanosis or edema \n Skin: Without rashes or lesions \n Neuro: A&Ox3. Cn 2 through 12 are intact.\n\nDISCHARGE EXAM\nVITALS: 97.9 ___ 18 95RA\nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclerae anicteric, MMM, oropharynx clear \nNECK: Supple, JVP not elevated, no LAD \nRESP: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nABD: exquisitely TTP to light touch diffusely\nGU: no foley \nEXT: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNEURO: CNs2-12 intact, motor function grossly normal', 'diagnoses': [{'icd_code': 'I130', 'desc': 'Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'N170', 'desc': 'Acute kidney failure with tubular necrosis'}, {'icd_code': 'R578', 'desc': 'Other shock'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'A0472', 'desc': 'Enterocolitis due to Clostridium difficile, not specified as recurrent'}, {'icd_code': 'F05', 'desc': 'Delirium due to known physiological condition'}, {'icd_code': 'J948', 'desc': 'Other specified pleural conditions'}, {'icd_code': 'I5023', 'desc': 'Acute on chronic systolic (congestive) heart failure'}, {'icd_code': 'K921', 'desc': 'Melena'}, {'icd_code': 'I482', 'desc': 'Chronic atrial fibrillation'}, {'icd_code': 'I255', 'desc': 'Ischemic cardiomyopathy'}, {'icd_code': 'D539', 'desc': 'Nutritional anemia, unspecified'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'M5030', 'desc': 'Other cervical disc degeneration, unspecified cervical region'}, {'icd_code': 'J984', 'desc': 'Other disorders of lung'}, {'icd_code': 'I081', 'desc': 'Rheumatic disorders of both mitral and tricuspid valves'}, {'icd_code': 'K9289', 'desc': 'Other specified diseases of the digestive system'}, {'icd_code': 'R001', 'desc': 'Bradycardia, unspecified'}, {'icd_code': 'I341', 'desc': 'Nonrheumatic mitral (valve) prolapse'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'R0902', 'desc': 'Hypoxemia'}, {'icd_code': 'M109', 'desc': 'Gout, unspecified'}, {'icd_code': 'Z96659', 'desc': 'Presence of unspecified artificial knee joint'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': 'ADMISSION LABS\n___ 03:00PM BLOOD WBC-9.0 RBC-4.86# Hgb-15.3# Hct-43.2 \nMCV-89 MCH-31.5 MCHC-35.4 RDW-13.6 RDWSD-44.4 Plt ___\n___ 05:07PM BLOOD ___ PTT-44.1* ___\n___ 03:00PM BLOOD Glucose-542* UreaN-20 Creat-0.9 Na-129* \nK-5.3* Cl-90* HCO3-21* AnGap-23*\n___ 03:00PM BLOOD ALT-25 AST-23 AlkPhos-181* TotBili-0.3\n___ 03:00PM BLOOD Lipase-14\n___ 03:17PM BLOOD cTropnT-<0.01\n___ 06:30AM BLOOD Calcium-9.8 Phos-5.2* Mg-1.7\n\nDISCHARGE LABS\n___ 06:24AM BLOOD WBC-5.5 RBC-4.12* Hgb-12.0* Hct-37.4* \nMCV-91 MCH-29.1 MCHC-32.1 RDW-13.5 RDWSD-45.5 Plt ___\n___ 06:24AM BLOOD Glucose-238* UreaN-11 Creat-0.8 Na-138 \nK-4.7 Cl-102 HCO3-21* AnGap-20\n___ 06:24AM BLOOD ALT-18 AST-21 LD(LDH)-200 AlkPhos-131* \nTotBili-0.2\n___ 06:24AM BLOOD Albumin-3.8 Calcium-9.2 Phos-6.4* Mg-1.6\n___ 01:18PM BLOOD ___ pO2-81* pCO2-44 pH-7.33* \ncalTCO2-24 Base XS--2\n\nMICRO\nUCX ___\nURINE CULTURE (Final ___: NO GROWTH.\n\nIMAGING\nCXR \nElevation of the left hemidiaphragm. Slight blunting of the \nleft costophrenic angle could be due to pleural thickening or \ntrace pleural effusion. No definite focal consolidation.\n___ yo M with history of T1DM, LUL lobectomy due to recurrent \npneumonia, and chronic abdominal pain reported to be ___ chronic \npancreatitis who presents from home for syncope and \nhyperglycemia.'}}
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{'final_diagnoses': ['Hyperglycemia'], 'procedures': ['None'], 'visit_summary': '___ yo M with history of T1DM, LUL lobectomy due to recurrent \npneumonia, and chronic abdominal pain reported to be ___ chronic \npancreatitis who presents from home for syncope and \nhyperglycemia.', 'medications_prescribed': []}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'M', 'symptoms': 'Post-operative monitoring after TIPS procedure', 'medical_history': ['Portal vein thrombosis, treated with Eliquis', 'Irritable bowel syndrome', 'Eczema', 'Menstrual irregularities', 'Cholelithiasis'], 'family_history': 'Per records: her family history is notable only for\nhyperlipidemia and ovarian cancer in her mother. She is unaware\nof her paternal medical history.', 'present_illness': "Ms ___ is a ___ year old morbidly obese woman with a\npast history of laparoscopic sleeve gastrectomy in ___ with a\npost-op course complicated by splanchnic and portal vein\nthrombosis status-post 6 months of anticoagulation with now\nunsuccessful ___ recannulation of the portal system.\nShe presented today for reattempt TIPS and recannulation.\n\nShe was last admitted at ___ on ___ after an unsuccessful\nTIPS, attempted due to a chronic portal-mesenteric-splenic\nthrombosis. She was monitored due to postprocedural pain, N/V. \nAs her symptoms were controlled at discharge, she was placed on\napixaban (10mg BID x 7d, followed by 5mg BID thereafter) with\nplans to present to ___ again in 4 weeks' time for a repeat\nattempt at TIPS. \n\nOn ___, Pt underwent TIPS. After procedure, patient \nreported\npain at TIPS site in neck and diffusely in abdomen.", 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pseudoephedrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TD', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'NORepinephrine', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IM', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxymetazoline', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Restasis', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Glycerophosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Brimonidine Tartrate 0.15% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT RELIABLY DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.4,. Estimated GFR = 49 if non African-American (mL/min/1.73 m2). Estimated GFR = 59 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '___', 'valuenum': 0.01, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.9', 'valuenum': 87.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 180.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.01, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '123', 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'163', 'valuenum': 163.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '417', 'valuenum': 417.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.50', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 151.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.1', 'valuenum': 19.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.23', 'valuenum': 3.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '435', 'valuenum': 435.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '491', 'valuenum': 491.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 22506.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 852.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'Admission Physical Exam:\n========================\nVS:97.8PO 96 / 61 72 16 98 Ra\nGENERAL: well-appearing in NAD, lying in bed \nHEENT: AT/NC, EOMI, anicteric sclera\nHEART: RRR, S1/S2, no murmurs\nLUNGS: CTAB, no wheezes, rales, rhonchi\nABDOMEN: soft, non-distended, pain to deep palpation in the \nupper quadrant (L>R), no guarding or rebound tenderness\nEXTREMITIES: no edema \nNEURO: alert, oriented X 3, conversant, CN grossly intact and\nmoving all 4 extremities with purpose \nSKIN: warm and well perfused, no rashes, bandage on R neck and R\nflank at TIPS site. No palpable hematoma. \nPSYCH: Pleasant mood, appropriate affect.\n\nDischarge Physical Exam:\n========================\nVS: T 99.1 BP 109/65 HR 84 RR 18 O2 90% on RA\nGENERAL: well-appearing female in NAD, lying in bed, listening \nto\nmusic.\nHEENT: AT/NC, EOMI, anicteric sclera\nHEART: RRR, S1/S2, no murmurs\nLUNGS: CTAB, taking deep breaths. \nABDOMEN: soft, non-distended, nontender to palpation in all 4\nquadrants without rebound or guarding.\nEXTREMITIES: no edema \nNEURO: alert, oriented X 3, conversant, CN grossly intact and\nmoving all 4 extremities with purpose \nSKIN: warm and well perfused, no rashes, bandage on R neck and R\nflank at TIPS site. No palpable hematoma. \nPSYCH: Pleasant mood, appropriate affect.', 'diagnoses': [{'icd_code': '80126', 'desc': 'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '37630', 'desc': 'Exophthalmos, unspecified'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '8026', 'desc': 'Closed fracture of orbital floor (blow-out)'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': 'E8844', 'desc': 'Accidental fall from bed'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': 'V4975', 'desc': 'Below knee amputation status'}, {'icd_code': '4439', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '3669', 'desc': 'Unspecified cataract'}, {'icd_code': '7847', 'desc': 'Epistaxis'}, {'icd_code': '9211', 'desc': 'Contusion of eyelids and periocular area'}, {'icd_code': '37272', 'desc': 'Conjunctival hemorrhage'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}, {'icd_code': '37420', 'desc': 'Lagophthalmos, unspecified'}, {'icd_code': 'V4502', 'desc': 'Automatic implantable cardiac defibrillator in situ'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '29420', 'desc': 'Dementia, unspecified, without behavioral disturbance'}], 'summary': "___ 08:33PM BLOOD WBC-7.2 RBC-4.17 Hgb-10.4* Hct-32.7* \nMCV-78* MCH-24.9* MCHC-31.8* RDW-14.2 RDWSD-40.4 Plt ___\n___ 06:35AM BLOOD ___ PTT-26.1 ___\n___ 06:35AM BLOOD Glucose-114* UreaN-17 Creat-0.5 Na-143 \nK-4.2 Cl-105 HCO3-23 AnGap-15\n___ 06:35AM BLOOD ALT-44* AST-43* LD(LDH)-174 AlkPhos-42 \nTotBili-0.5\n___ 06:35AM BLOOD Calcium-8.6 Phos-4.4 Mg-1.9 Iron-34\n___ 03:36PM BLOOD Hgb-10.9* calcHCT-33\n\nDischarge Labs:\n___ 10:30AM BLOOD WBC-6.0 RBC-3.72* Hgb-9.2* Hct-29.3* \nMCV-79* MCH-24.7* MCHC-31.4* RDW-14.3 RDWSD-40.9 Plt ___\n___ 06:25AM BLOOD ___ PTT-27.9 ___\n___ 06:25AM BLOOD Glucose-82 UreaN-12 Creat-0.5 Na-142 \nK-3.9 Cl-105 HCO3-27 AnGap-10\n___ 06:25AM BLOOD ALT-38 AST-27 AlkPhos-45 TotBili-0.4\n___ 06:25AM BLOOD Albumin-3.6 Calcium-8.3* Phos-3.5 Mg-1.9\nSummary:\n-------- \n___ is a ___ year-old female with history of splanchnic \nand portal vein thrombosis following laparoscopic sleeve \ngastrectomy in ___, who was admitted status post ___ TIPS \nattempt on ___ for monitoring\n\nActive Issues:\n---------------\n# Portal Vein Thrombosis: The patient has a history of failed \nTIPS ___, and has been on apixiban 5mg daily since then. \nShe underwent ___ TIPS on ___. Her procedure was \ncomplicated by splenic vein rupture, which was stented over \nwithout issue. Her hemoglobin remained stable. She was \nanticoagulated with a heparin drip overnight, and transitioned \nto apixiban on ___. Post-operative pain was managed with \noxycodone 5mg PO q4hrs. Patient's pain was improved, and her \nhemoglobin/hemodynamics were stable at discharge.\n\nChronic Issues:\n----------------\n#Laparoscopic sleeve gastrectomy\n- Continued on daily multivitamin\n\n# Chronic Pain: \n- Continued gabapentin\n\nTransitional Issues:\n--------------------\n[] TIPS Ultrasound: The patient will need outpatient follow up \nwith the ___ and ultrasound of her TIPS within a few \nweeks of discharge to monitor TIPS patency. Please call the \nInterventional Radiology department to schedule this.\n\n[] Work Letter: The patient should not go back to work as a \n___ or ___ until ___. \nPlease read the attached work letter. \n\n[] Follow-up labs:\nPlease obtain CBC, chem10, LFT's, coags on ___. Please fax \nresults to the ___ (fax ___ and PCP \n___, fax ___. \n\n[] CODE STATUS: Full \n[] CONTACT: ___ ___"}}
|
{'final_diagnoses': ['Status post transjugular intrahepatic portosystemic shunt, \ncomplicated by splenic vein rupture', 'History of splanchnic and portal vein thrombosis', 'History of chronic pain'], 'procedures': ['Transjugular intrahepatic portosystemic shunt ___'], 'visit_summary': "Summary:\n-------- \n___ is a ___ year-old female with history of splanchnic \nand portal vein thrombosis following laparoscopic sleeve \ngastrectomy in ___, who was admitted status post ___ TIPS \nattempt on ___ for monitoring\n\nActive Issues:\n---------------\n# Portal Vein Thrombosis: The patient has a history of failed \nTIPS ___, and has been on apixiban 5mg daily since then. \nShe underwent ___ TIPS on ___. Her procedure was \ncomplicated by splenic vein rupture, which was stented over \nwithout issue. Her hemoglobin remained stable. She was \nanticoagulated with a heparin drip overnight, and transitioned \nto apixiban on ___. Post-operative pain was managed with \noxycodone 5mg PO q4hrs. Patient's pain was improved, and her \nhemoglobin/hemodynamics were stable at discharge.\n\nChronic Issues:\n----------------\n#Laparoscopic sleeve gastrectomy\n- Continued on daily multivitamin\n\n# Chronic Pain: \n- Continued gabapentin\n\nTransitional Issues:\n--------------------\n[] TIPS Ultrasound: The patient will need outpatient follow up \nwith the ___ and ultrasound of her TIPS within a few \nweeks of discharge to monitor TIPS patency. Please call the \nInterventional Radiology department to schedule this.\n\n[] Work Letter: The patient should not go back to work as a \n___ or ___ until ___. \nPlease read the attached work letter. \n\n[] Follow-up labs:\nPlease obtain CBC, chem10, LFT's, coags on ___. Please fax \nresults to the ___ (fax ___ and PCP \n___, fax ___. \n\n[] CODE STATUS: Full \n[] CONTACT: ___ ___", 'medications_prescribed': ['Acetaminophen 500 mg PO Q8H:PRN Pain - Moderate', 'Apixaban 5 mg PO BID', 'Gabapentin 300 mg PO BID', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate', 'Outpatient Lab Work\nD64.9: Anemia', "Please obtain CBC, chem10, LFT's, coags on ___. Please fax \nresults to the ___ (fax ___ and PCP \n___, fax ___."]}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 76, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ["Crohn's diagnosed in ___, followed at ___. No past \nsurgeries for Crohn's, no immunomodulators.", 'Depression', 'HTN'], 'family_history': 'Possible history of IBD in his dad (never formally diagnosed).', 'present_illness': "Mr. ___ is a ___ year old male with a pmh of Crohn's disease, \ndepression, hypertension and GERD who presented with severe, \ncentrally located, acute on chonic abdominal pain. \n\nHe has had pain that is a dull ache and centrally located over \nthe past ___ weeks. He has been treated for GERD for this and \nhas had an evaluation with an ultrasound. He had no episodes of \nnausea/vomiting, fever, or worsening diarrhea over that time. \nYesterday he developed acute abdominal pain with nausea and one \nepisode of emesis. He typically passes a lot of gas, but did not \npass any over the ___ hours prior to presentation. He had a \nnormal bowel movement yesterday prior to the onset of pain. He \ncame home from work and had persistent pain so he was brought to \nthe ED. \n\nIn the ED:\nInitial vital signs: 96.9 75 153/76 16 96% on RA\nAccess: 18g PIV\nFluids: None given\nLabs significant for: WBC of 12.3\nStudies: CT scan showed active Crohn's in the terminal ileum and \nSBO\nMeds: None given\n\nBy this morning his pain had improved quite a bit, is now dull \nand achy and is centrally located. He has begun passing gas. He \nhad no further emesis or nausea, and has not required treatment \nfor pain or nausea. \n\nROS: Pertinent positive and negative as above. In addition, he \ndenied fever, chest pain, persistent nausea, vomiting. No blood \nin his stool. No BM today. He has started passing gas again this \nmorning. Abdominal pain is back to dull.", 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Oncology)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride Replacement (Oncology)', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Methimazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Guaifenesin-Dextromethorphan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '365', 'valuenum': 365.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '39.6', 'valuenum': 39.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '394', 'valuenum': 394.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '239', 'valuenum': 239.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20100', 'valuenum': 20100.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': 'PLEURAL FLUID.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '359', 'valuenum': 359.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '325', 'valuenum': 325.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Exam: \nVitals: 98.3, 128/80, 52, 20, 94% on RA\nPain: ___\nGen: Well appearing male, NAD\nHEENT: MMM, anicteric\nCV: no JVD, normal rate, regular rhythm\nResp: CTAB, no wheezes, rales, rhonchi\nGI: Soft, very mildly tender to palpation in the RLQ\nSkin: No rash noted on limited exam\nPsych: normal mood and affect\nNeuro: normal facial symmetry, easy speech, moving around \nwithout issue', 'diagnoses': [{'icd_code': '1983', 'desc': 'Secondary malignant neoplasm of brain and spinal cord'}, {'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '2930', 'desc': 'Delirium due to conditions classified elsewhere'}, {'icd_code': '51181', 'desc': 'Malignant pleural effusion'}, {'icd_code': '0413', 'desc': "Friedländer's bacillus infection in conditions classified elsewhere and of unspecified site"}, {'icd_code': '04149', 'desc': 'Other and unspecified Escherichia coli [E. coli]'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '7837', 'desc': 'Adult failure to thrive'}, {'icd_code': '3383', 'desc': 'Neoplasm related pain (acute) (chronic)'}, {'icd_code': '3320', 'desc': 'Paralysis agitans'}, {'icd_code': '78720', 'desc': 'Dysphagia, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '78830', 'desc': 'Urinary incontinence, unspecified'}, {'icd_code': '71536', 'desc': 'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V1011', 'desc': 'Personal history of malignant neoplasm of bronchus and lung'}, {'icd_code': 'V153'}], 'summary': "___ 09:30PM BLOOD WBC-12.3*# RBC-4.47* Hgb-14.7 Hct-44.5 \nMCV-100* MCH-32.9* MCHC-33.1 RDW-13.1 Plt ___\n___ 09:30PM BLOOD Neuts-83.3* Lymphs-8.6* Monos-6.0 Eos-1.8 \nBaso-0.3\n___ 09:30PM BLOOD Glucose-142* UreaN-20 Creat-0.9 Na-136 \nK-4.0 Cl-103 HCO3-26 AnGap-11\n\nIMAGING:\nCT abdomen and pelvis with contrast: Preliminary report\nFINDINGS: \n \nBibasilar atelectasis is seen. Otherwise, the visualized lung \nbases are clear. \n\nABDOMEN: LIVER: Tiny hypodensities too small to characterize but \nlikely \nrepresenting hepatic cysts are seen in the right lobe of the \nliver. The liver is otherwise homogeneous with no focal lesions. \nThere is no biliary ductal dilatation. \n \nGALLBLADDER: The gallbladder is normal in appearance. \n \nPANCREAS: The pancreas is unremarkable. \n \nSPLEEN: The spleen shows normal size and attenuation throughout, \nwithout evidence of focal lesions. \n \nADRENALS: The adrenal glands are unremarkable bilaterally. \n \nKIDNEYS: A hypodensity likely representing a renal cyst is seen \nin the right kidney. Otherwise, the kidneys are normal in \nappearance. \n \nGI: The stomach and duodenum are normal in caliber and \nunremarkable. Approximately 15 cm of terminal ileum demonstrates \nwall thickening and edema and mild adjacent fat stranding, \nconsistent with an active Crohn's flare.Upstream of this \ninflamed segment of bowel, there is dilation of the ileum up to \n4.3 cm, and no oral contrast is seen passing through this \nsegment of terminal ileum. Findings are consistent with a small \nbowel obstruction secondary to Crohn's changes in the terminal \nileum. Evaluation of the area of flare is somewhat limited due \nto use of positive oral contrast. \n \nRETROPERITONEUM: There is no retroperitoneal or mesenteric \nlymphadenopathy. \n \nVASCULAR: The abdominal aorta is normal in appearance. \n\nPELVIS: The sigmoid colon and rectum are normal in appearance. \nThe distal ureters and bladder are normal. There is no pelvic or \ninguinal lymphadenopathy. There is trace free fluid in the \npelvis. \n\nBONES AND SOFT TISSUES: No focal lytic or sclerotic osseous \nlesions suspicious for infection or malignancy are seen. \n \nIMPRESSION: \n \n1. Wall thickening and edema in the terminal ileum with mild \nadjacent fat stranding, consistent with an active Crohn's flare. \n\n \n2. Upstream of the inflamed terminal ileum, there is dilation of \nthe ileum up to 4.3 cm, and no oral contrast is seen passing \nthrough the terminal ileum. Findings are consistent with small \nbowel obstruction secondary to Crohn's changes in the terminal \nileum. If clinically desired, followup radiographs may be \nobtained to assess for delayed passage of contrast through the \nterminal ileum.\n___ year old male with a history of Crohn's on sulfasalazine, who \npresents with acute severe abdominal pain on subacute abdominal \npain, consistent with a Crohn's flare.\n\n1. Abdominal pain with nausea/vomiting, and Crohn's flare and \nsmall bowel obstruction: Consistent with a Crohn's flare on CT \nscan as well as a small bowel obstruction upstream from the \ninflammation of the terminal ileum. He was treated with IV \nsolumedrol 20mg Q8H x2 days, and transitioned to 40mg PO \nprednisone with a plan to taper by 5mg weekly. His sulfasalazine \nwas discontinued. His abdominal pain resolved with conservative \nmanagement, and over the course of the first day of admission he \nbegan passing gas. He was kept NPO x1 day, then his diet was \nadvanced to clears followed by low residue diet, which was \ntolerated without complication. He had bowel movements on \nconsecutive days prior to discharge. He will follow-up with his \nGI physician for ongoing management post-hospitalization. He was \nprovided a handout for low residue diet and the number for the \nGI clinic at ___ if he decided to be seen in follow-up at \n___. GI followed throughout his hospitalization. \n\n2. HTN: He was continued on his home Lisinopril 5mg daily.\n\n3. Depression: He was continued on his Fluoxetine 20mg daily."}}
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{'final_diagnoses': ["Crohn's flare"], 'procedures': ['None'], 'visit_summary': "___ year old male with a history of Crohn's on sulfasalazine, who \npresents with acute severe abdominal pain on subacute abdominal \npain, consistent with a Crohn's flare.\n\n1. Abdominal pain with nausea/vomiting, and Crohn's flare and \nsmall bowel obstruction: Consistent with a Crohn's flare on CT \nscan as well as a small bowel obstruction upstream from the \ninflammation of the terminal ileum. He was treated with IV \nsolumedrol 20mg Q8H x2 days, and transitioned to 40mg PO \nprednisone with a plan to taper by 5mg weekly. His sulfasalazine \nwas discontinued. His abdominal pain resolved with conservative \nmanagement, and over the course of the first day of admission he \nbegan passing gas. He was kept NPO x1 day, then his diet was \nadvanced to clears followed by low residue diet, which was \ntolerated without complication. He had bowel movements on \nconsecutive days prior to discharge. He will follow-up with his \nGI physician for ongoing management post-hospitalization. He was \nprovided a handout for low residue diet and the number for the \nGI clinic at ___ if he decided to be seen in follow-up at \n___. GI followed throughout his hospitalization. \n\n2. HTN: He was continued on his home Lisinopril 5mg daily.\n\n3. Depression: He was continued on his Fluoxetine 20mg daily.", 'medications_prescribed': ['1. Cyanocobalamin 1000 mcg PO DAILY', '2. Fluoxetine 20 mg PO DAILY', '3. Lisinopril 5 mg PO DAILY', '4. Omeprazole 40 mg PO DAILY', '5. Vitamin D 1000 UNIT PO DAILY', '6. PredniSONE 40 mg PO DAILY \nPlease taper down by 5mg weekly \nRX *prednisone 5 mg 8 tablet(s) by mouth daily Disp #*252 Tablet \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 30, 'gender': 'F', 'symptoms': 'respiratory distress', 'medical_history': ['___ \n- metastatic to brain \n- s/p XRT 30 Gy \n- s/p WBT \n- last chemotherapy ___ \nCOPD', 'Chronic bronchitis', 'Atrial fibrillation (not on anticoagulation currently)', "Graves' disease"], 'family_history': 'Breast ca in sister, Mother with DM2, Father died of MI; no \nfamily hx of lung cancer', 'present_illness': '___ with recurrent NSCLC/adeno Ca, s/p external beam XRT/Chemo \nStage IIIB T4N2M0); not a candidate for cyber-knife given spread \nof disease, transferred from ___ for IP \nconsultation/procedure. \n\nThe patient presented to ___ on ___ with \nworsening respiratory status and wheezing at home as well as \nsinus congestion. She was admitted initially for a COPD \nexacerbation. Please see discharge summary from ___ for \nfull details. In summary, she was started on prednisone with \ntransition to methylprednisolone 62.5 mg IV Q6H. She was \neventually placed back on prednisone 40 mg daily. While there, \nPulmonary Service evaluation found that patient had progression \nof her lung cancer with enlargement of subcarinal endobronchial \nlesion that encroached on right main stem bronchus. Given \nconcern for worsening pulmonary disease, she was transferred to \n___ for IP consideration to manage airway obstruction. \n\nOtherwise, patient has been on palliative chemotherapy with her \noncologist, Dr. ___ Oncology/Hematology. \nPalliative Care saw the patient as well at ___. At \nthe time of transfer, she was noted to be full code. VS upon \ntransfer were Temp 97.7, BP 98/76, RR 16, Sats 99% on 2L NC. \n\nOn the floor, the patient still feels a bit wheezy and \ncongested. She feels short of breath constantly at baseline. No \nfevers or chills. She thinks she has lost a few pounds in the \npast few month. No headache, dizziness, lightheadedness, nausea, \nvomiting, diarrhea, abdominal pain, palpitations, chest pain, or \ndysuria. \n\nOf note, she last had chemotherapy approximately a month ago, \nshe was due for another cycle (which is every 21 days) just a \nweek prior to admission.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'METHADONE ASSAY DETECTS ONLY METHADONE (NOT OTHER OPIATES/OPIOIDS).'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OPIATE IMMUNOASSAY SCREEN DOES NOT DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.17', 'valuenum': 4.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Cloudy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '295', 'valuenum': 295.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '___', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVitals: T 97.3, BP 107/50, HR 104, RR 20, SAT 100% on 2___\nGeneral: Alert, oriented, no acute distress, lethargic appearing \nthough \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL \nNeck: Supple, JVP not elevated \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Diffuse end expiratory rhonchi \nAbdomen: Soft, mild abdominal tenderness, non-distended, bowel \nsounds present, no organomegaly, no rebound or guarding \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro: Grossly normal with no signs of motor weakness or \nasymmetry \n\nDISCHARGE PHYSICAL EXAM:\nVS: 98.8 ___ 97-99% ___\nGENERAL: NAD, alert, interactive \nHEENT: MM dry\nLUNGS: ronchorous breath sounds throughout \nHEART: RRR S1 and S2 no m/r/g\nABDOMEN: BS+, soft, NT, ND. \nEXTREMITIES: WWP, no edema \nNEURO: awake, A&Ox3', 'diagnoses': [{'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '72888', 'desc': 'Rhabdomyolysis'}, {'icd_code': '2769', 'desc': 'Electrolyte and fluid disorders not elsewhere classified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '7291', 'desc': 'Myalgia and myositis, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}, {'icd_code': '34700', 'desc': 'Narcolepsy, without cataplexy'}, {'icd_code': '30520', 'desc': 'Cannabis abuse, unspecified'}, {'icd_code': '6259', 'desc': 'Unspecified symptom associated with female genital organs'}], 'summary': '==ADMISSION LABS==\n___ 05:35AM BLOOD WBC-13.8*# RBC-3.71* Hgb-10.3* Hct-33.5* \nMCV-90 MCH-27.8 MCHC-30.7* RDW-17.5* RDWSD-55.3* Plt ___\n___ 05:35AM BLOOD ___ PTT-24.1* ___\n___ 05:35AM BLOOD Glucose-99 UreaN-31* Creat-0.6 Na-140 \nK-4.3 Cl-101 HCO3-29 AnGap-14\n___ 05:35AM BLOOD ALT-130* AST-79* LD(LDH)-219 AlkPhos-73 \nTotBili-0.1\n___ 05:35AM BLOOD Albumin-3.2* Calcium-9.2 Phos-2.6* Mg-2.1\n\n==DISCHARGE LABS==\n___ 06:12AM BLOOD WBC-8.1 RBC-3.71* Hgb-10.3* Hct-33.7* \nMCV-91 MCH-27.8 MCHC-30.6* RDW-17.6* RDWSD-57.0* Plt ___\n___ 06:12AM BLOOD Glucose-77 UreaN-19 Creat-0.6 Na-142 \nK-4.6 Cl-102 HCO3-33* AnGap-12\n___ 06:12AM BLOOD Calcium-8.6 Phos-3.1 Mg-2.2\n\n==IMAGING==\nComparison to ___. Minimal increase in extent of a \npre-existing right pleural effusion with subsequent right \nbasilar atelectasis. The position of a right hilar fiducial \nmarker is constant. Status post placement of a stent in the \nleft main bronchus. The bronchus appears patent. No pathologic \nchanges in the left lung parenchyma. \n\n==PROCEDURAL REPORTS==\n___: Rigid bronchoscopy and left main stem bronchus stent \nplacement\n___ with recurrent metastatic NSCLC/adenocarcinoma s/p external \nbeam XRT and chemotherapy is transferred from OSH with tumor \nobstructing bronchus, now s/p IP stent.'}}
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{'final_diagnoses': ['Left Main Bronchus Occlusion', 'Metastatic Non-Small Cell Lung Cancer', 'COPD', 'Atrial Fibrillation', 'Malnutrition', 'Chronic Bronchitis'], 'procedures': ['___: Rigid bronchoscopy and left main stem bronchus stent \nplacement'], 'visit_summary': '___ with recurrent metastatic NSCLC/adenocarcinoma s/p external \nbeam XRT and chemotherapy is transferred from OSH with tumor \nobstructing bronchus, now s/p IP stent.', 'medications_prescribed': ['CT Airway\nCT Airway in 4 weeks (week of ___', 'ICD9 162', 'Contact: ___, MD', 'Phone: ___ \nFax: ___', 'Cetirizine 10 mg PO DAILY', 'Mirtazapine 30 mg PO QHS', 'Omeprazole 20 mg PO DAILY', 'Tiotropium Bromide 1 CAP IH DAILY', 'Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 58, 'gender': 'M', 'symptoms': 'Abdominal pain', 'medical_history': ['-Type 2 IDDM', '-Chronic pancreatitis with question of pseudocyst'], 'family_history': 'Denies any known history of malignancies, pancreaticobiliary \ndisease, or heart disease.', 'present_illness': "Patient is a ___ yo F h/o chronic pancreatitis and type 2 DM who \ninitailly presented to an OSH with abd pain. Pain has been \noccuring over last two weeks and has progressively worsened. \nPain is worsened with eating. It is a sharp ___ pain that \nradiates to her back. She was nauseated and vomited a few times \nlast week,but she attributed this to Vicodin which was \nprescribed by her PCP. She initially thought that this was her \nchronic pancreatitis pain. She has had pain like this in the \npast, at least a dozen prior episodes in recent years. She \ndenies fevers/chills, weight loss, diarrhea, BRBPR or melena. \nShe reports having regular BM's. She was seen at the OSH, where \nher LFT's were noted to be markedly elevated. She was \ntransferred for evaluation for possible ERCP.", 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'VinBLAStine (Velban)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim SS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Gluconate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Filgrastim', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DOXOrubicin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '5X/DAY', 'doses_per_24_hrs': 5.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sotalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dacarbazine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Fosaprepitant', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81.6', 'valuenum': 81.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '239', 'valuenum': 239.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 160.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '___', 'valuenum': 0.27, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LEVELS SHOULD BE OBTAINED 4-6 HRS AFTER LAST SUBCUTANEOUS DOSE OF LMWH.;THERAPEUTIC RANGES FOR VENOUS THROMBOSIS: 0.6-1.0 U/ML FOR BID DOSING..'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 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32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 192.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 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'comments': '1+.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': 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'priority': 'ROUTINE', 'comments': None}, {'value': '233', 'valuenum': 233.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '326', 'valuenum': 326.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.41, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LEVELS SHOULD BE OBTAINED 4-6 HRS AFTER LAST SUBCUTANEOUS DOSE OF LMWH.;THERAPEUTIC RANGES FOR VENOUS THROMBOSIS: 0.6-1.0 U/ML FOR BID DOSING..'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '264', 'valuenum': 264.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '505', 'valuenum': 505.0, 'valueuom': 'IU/L', 'ref_range_lower': 8.0, 'ref_range_upper': 61.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL. MANUALLY COUNTED.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 66.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TOXIC GRANULATIONS.'}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.88', 'valuenum': 2.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '237', 'valuenum': 237.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'ug/dL', 'ref_range_lower': 4.6, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69.9', 'valuenum': 69.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '242', 'valuenum': 242.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'mg/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '409', 'valuenum': 409.0, 'valueuom': 'IU/L', 'ref_range_lower': 8.0, 'ref_range_upper': 61.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '297', 'valuenum': 297.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.68, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LEVELS SHOULD BE OBTAINED 4-6 HRS AFTER LAST SUBCUTANEOUS DOSE OF LMWH.;THERAPEUTIC RANGES FOR VENOUS THROMBOSIS: 0.6-1.0 U/ML FOR BID DOSING..'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78.8', 'valuenum': 78.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '307', 'valuenum': 307.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.98', 'valuenum': 2.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '246', 'valuenum': 246.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical Exam:\nAppearance: NAD, Appears uncomfortable.\nVitals: T: 97.3 BP: 100/60 HR: 72 RR: 22 O2: 99 % RA\nEyes: EOMI, PERRL, conjunctiva clear, noninjected, anicteric, no \nexudate\nENT: Moist\nNeck: No JVD, no LAD, no thyromegaly, no carotid bruits\nCardiovascular: RRR, nl S1/S2, no m/r/g\nRespiratory: CTA bilaterally, comfortable, no wheezing, no \nronchi, no rales\nGastrointestinal: soft, diffusely tender to palpation, voluntary \nguarding, no rebound, non-distended, no hepatosplenomegaly, \nnormal bowel sounds\nMusculoskeletal/Extremities: no clubbing, no cyanosis, no joint \nswelling, no edema in the bilateral extremities\nNeurological: Alert and oriented x 3, fluent speech, no pronator \ndrift, no asterixis, sensation WNL, CNII-XII intact\nIntegument: warm, no rash, no ulcer, no jaundice\nPsychiatric: appropriate, pleasant\nHematological/Lymphatic: No cervical, supraclavicular, axillary, \nor inguinal lymphadenopathy', 'diagnoses': [{'icd_code': '0529', 'desc': 'Varicella without mention of complication'}, {'icd_code': '4162', 'desc': 'Chronic pulmonary embolism'}, {'icd_code': '20192', 'desc': "Hodgkin's disease, unspecified type, intrathoracic lymph nodes"}, {'icd_code': '135', 'desc': 'Sarcoidosis'}, {'icd_code': '27669', 'desc': 'Other fluid overload'}, {'icd_code': '5178', 'desc': 'Lung involvement in other diseases classified elsewhere'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': '45829', 'desc': 'Other iatrogenic hypotension'}], 'summary': '___ 10:22PM WBC-11.4* RBC-3.94* HGB-12.8 HCT-38.2 MCV-97 \nMCH-32.4* MCHC-33.4 RDW-14.6\n___ 10:22PM NEUTS-73.2* ___ MONOS-6.0 EOS-0.8 \nBASOS-0.5\n___ 10:22PM PLT COUNT-361\n___ 10:22PM GLUCOSE-61* UREA N-9 CREAT-0.4 SODIUM-137 \nPOTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-28 ANION GAP-11\n___ 10:22PM ALT(SGPT)-180* AST(SGOT)-154* ALK PHOS-2285* \nAMYLASE-34 TOT BILI-2.9*\n___ 10:22PM LIPASE-10\n___ 01:10AM LACTATE-0.7\n___ 12:43AM ___ PTT-29.4 ___\n.\nLFTs ___: ALT 120, AST, 164, Alk Phos 2611, Total Bili 1.9, \nLipase 9 \n \n.\nRUQ U/S: \n___ ULTRASOUND: Grayscale and color Doppler \nsonographic images\nwere obtained that demonstrate the liver to be of normal \nechotexture,\nechogenicity and contour. There is no flow in what appears to be \nthe portal\nvein but without echogenic internal material. Nonetheless this \nraises the\npossibility of cavernous transformation. The gallbladder \ndemonstrates numerous\nfolds but there is no cholelithiasis, pericholecystic fluid or \nwall\nthickening. There is no ascites. The main hepatic artery \ndemonstrates a\nprompt upstroke and antegrade diastolic flow. The right kidney \nmeasures 10.8\ncm pole to pole and the left 11.5 without evidence for \nhydronephrosis,\nnephrolithiasis or solid renal mass. In the lower pole there is \na small 7mm\ndiameter likely cyst. The spleen is normal in terms of \nechotexture and\nmeasures to 10.1 cm.\n \nIMPRESSION:\n \n1. No flow in portal vein raising the possibility of portal vein \nthrombus and\ncavernous transformation.\n \n2. Hepatic artery flow normal.\n \n\n.\nCT abdomen:\nNDICATION: Abdominal pain.\n \nCOMPARISON: Ultrasound from ___. \n \nTECHNIQUE: Volumetric CT acquisition of the abdomen was \nperformed before and\nafter administration of the intravenous contrast per pancreatic \nCTA protocol.\nMultiplanar reformatted images were obtained and reviewed.\n \nFINDINGS: Liver contour is normal. No focal liver mass is seen. \nModerate\nbiliary ductal dilatation is seen throughout the liver. The \nextrahepatic\ncommon hepatic duct measures up to 10 mm in greatest axial \ndiameter. There is low insertion of the cystic duct, which is \nalso dilated. The short segment of common bile duct is also \ndilated, but smoothly tapers to normal caliber, within the head \nof the pancreas, without evidence of obstructing stone or mass. \nThe gallbladder is mildly distended, but there is no sign of \ngallstone, wall thickening, or pericholecystic fluid. There is \nno ascites.\n \nThe pancreas is markedly abnormal in appearance, with numerous \ncoarse\ncalcifications scattered through the parenchyma, predominantly \nin the head and body of the pancreas. There are two irregularly \nmarginated hypodense\ncollections, one in the head of the pancreas measuring 3.0 x 2.0 \ncm (3A, 57), and the second in the mid body of the pancreas \nmeasuring 3.0 x 1.7 cm (3A,37). The course of the pancreatic \nduct is difficult to follow, as it is\ndilated in some areas (3A, 47), but not visible in other areas, \nsuggesting\nirregular stricture, or obstruction from calcifications. \nPancreatic parenchyma otherwise enhances within normal limits, \nwithout evidence of necrosis. There is no peripancreatic \ninflammatory stranding.\n \nThe portal vein is occluded, with cavernous transformation, and \nnumerous\nmesenteric collaterals along the course of the superior \nmesenteric vein. The splenic vein is also occluded, with \nprominent splenic and gastric varices seen in the left upper \nquadrant. Multiple coarse calcifications along the greater \ncurvature of the gastric fundus may also represent sequela of \nprior pancreatitis. There is moderate splenomegaly.\n \nKidneys enhance and excrete contrast symmetrically. There is no\nhydronephrosis. Adrenal glands are normal in size bilaterally. \nStomach and\nintra-abdominal loops of bowel are unremarkable. There is no \nfree\nintraperitoneal air, or abnormal intra-abdominal \nlymphadenopathy.\n \nAbdominal aorta is normal in caliber and contour throughout. \nThere is minor\natherosclerosis at the bifurcation. Conventional hepatic \narterial vasculature is widely patent. SMA and ___ are widely \npatent. Single right renal artery,and duplicated left renal \narteries are widely patent.\n \nThere is no osseous lesion suspicious for malignancy.\n \nIMPRESSION:\n \n1. Findings most consistent with chronic pancreatitis including \nmultiple\ncoarse calcifications throughout the pancreas, with likely areas \nof irregular narrowing and stricture, resulting in areas of \npancreatic ductal dilatation, as well as intra- and \nextra-hepatic biliary ductal dilatation. ERCP is recommended for \nfurther evaluation.\n \n2. Findings consistent with portal vein and splenic vein \nocclusion, with\ncavernous transformation of the portal vein, and multiple \nsplenic and gastric varices in the left upper quadrant.\n \n3. Two irregularly marginated fluid collections within the \npancreatic\nparenchyma likely represent pancreatic pseudocysts given the \nabove findings\nsuggestive of chronic pancreatitis. Cystic pancreatic neoplasm \nis considered much less likely.\n .\n___: Endoscopic Ultrasound\nFindings: Esophagus: \n Other A limited examination of the esophagus was normal \nStomach: \n Other A limited examination of the stomach was normal \nDuodenum: \n Other A limited examination of the duodenum was normal. \nEUS\nfindings: EUS was performed using a linear echoendoscope at 7.5 \nMHz frequency: The head and uncinate pancreas were imaged from \nthe duodenal bulb and the second / third duodenum. The body and \ntail were imaged from the gastric body and fundus. \n\nPancreatic head: The pancreatic parenchyma was hypoechoic, with \ndiffuse stranding and calcification, and lobularity. A \nunilocular cystic lesion, 3cm x 2cm, with a poorly defined \nmargin, sugggestive of an evolving pseudocyst, was noted in the \npancreatic head. No discrete mass was noted. \n\nPancreatic body and tail: The pancreatic parenchyma was \nhypoechoic, with diffuse stranding and calcification, and \nlobularity. The cystic lesion in the body noted on CT was not \nidentified on this study.\n\nPancreatic duct: The duct was difficult to visualise in the head \nand had an irregular contour with areas of dilation (3mm) in the \nbody and tail of the pancreas. \n\nBiliary tree: The provimal CBD and cystic duct were mildly \ndilated 8mm. The CBD tapered smoothly in the pancreatic head. \nThe ampulla was not clearly identified. A tiny amount of sludge, \nwithout acoustic shadowing, noted in the CBD. Sludge and \nmicrolithiasis was noted in the gallbladder.\n\nLymphnodes: No significant peripancreatic or celiac adenopathy \nwas noted.\n\nSplenic hilum varices were noted. \n \n \nImpression: Hypoechoic pancreatic parenchyma with stranding, \ncalcification and lobularity. \nIrregular Pancreatic duct \nEvolving pancreatic head pseudocyst \nProximal CBD dilation with smooth distal taper \nChanges of chronic pancreatitis. No focal mass identified in \npancreatic head. \nGallbladder sludge and microlithiasis, tiny amount of CBD sludge\n___ yo F with h/o chronic pancreatitis and diabetes admitted \nwith abdominal pain and Alk phos/Bilirubin elevation concerning \nfor biliary obstruction.\n.\n# Chronic pancreatitis/Biliary obstruction/Abdominal pain: Pain \nlikely related to pts chronic pancreatitis as her pain was \nsimilar to prior episodes and pt continued to drink alcohol on a \nregular basis. Pt noted to have elevated bilirubin/alkaline \nphosphatase (greater than LFT elevation), concerning for biliary \nobstruction. Admission labs notable for bilirubin of 3.1, alk \nphos 2285, AST 154, ALT 180. ERCP and Surgery were consulted in \nthe ED, with no necessary acute surgical intervention needed. US \nof the abdomen comments on lack of portal vein flow, likely due \nto chronic portal vein thrombosis. CTA pancreas shows multiple \ncoarse pancreatic calcifications, and areas of irregular \nnarrowing and stricture, resulting in areas of pancreatic ductal \ndilatation, and moderate intra- and extra-hepatic biliary ductal \ndilatation. It also comments on 2 pancreatic head cystic \nlesions, likely c/w pseudocyts. Suspected biliary obstruction \nwas likely due to strictures related to pts chronic \npancreatitis. Pt was treated with IV dilaudid for pain, changed \nto oral once tolerating po. EUS was performed to further \nevaluate biliary tree and pancreatic cysts. This showed \nhypoechoic pancreatic parenchyma with stranding, calcification \nand lobularity. Also noted irregular Pancreatic duct, evolving \npancreatic head pseudocyst, proximal CBD dilation with smooth \ndistal taper, and changes of chronic pancreatitis. Gallbladder \nsludge and microlithiasis, tiny amount of CBD sludge were noted. \nIt was felt that patient should have a repeat EUS in ___ weeks \nto reassess the pancreatic parenchyma for any masses/malignancy \nas the pancreas was too inflamed at this time to fully assess \nfor masses. In addition, the sludge in the CBD and gallbladder \nwere felt to be either due to NPO/poor po intake recently vs. a \npossible etiology of her pancreatitis flare. ERCP service \nrecommended surgical evaluation for cholecystectomy after \ndischarge. On day of discharge and day prior to discharge, pt \nwas tolerating a regular diet, walking outside to smoke, and \ntolerating po dilaudid for pain. Social work saw pt prior to \ndischarge to offer alcohol cessation programs. The patient is \nnot interested in cessation of her drinking at this time, but \nhas cut back on her drinking recently as much as she feels she \ncan given financial/social stressors. LFTs on day of discharge: \nALT 120, AST, 164, Alk Phos 2611, Total Bili 1.9, Lipase 9. \nAgain, needs outpatient repeat EUS/GI follow up, as well as \nsurgical evaluation for cholecystectomy. Needs LFTs trended \n(likely will take several weeks to fall).\n.\n# Chronic portal vein/splenic vein occlusion: Pt noted to have \ncavernous transformation of the portal vein, and multiple \nsplenorenal and gastric varices as well. CT and US do not \ncomment on presence of cirrhosis. Most likely these occlusions \nare due to chronic pancreatitis. No intervention needed\n.\n# Gastric varices: Noted on CT scan. Likely due to splenic vein \nocclusion.\n.\n# Type 2 DM, controlled, no complications: Gave ___ dose Lantus \nand insulin while here.'}}
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{'final_diagnoses': ['Chronic pancreatitis', 'Biliary Dilation', 'Hyperbilirubinemia', 'Abdominal pain'], 'procedures': ['Endoscopic ultrasound ___'], 'visit_summary': '___ yo F with h/o chronic pancreatitis and diabetes admitted \nwith abdominal pain and Alk phos/Bilirubin elevation concerning \nfor biliary obstruction.\n.\n# Chronic pancreatitis/Biliary obstruction/Abdominal pain: Pain \nlikely related to pts chronic pancreatitis as her pain was \nsimilar to prior episodes and pt continued to drink alcohol on a \nregular basis. Pt noted to have elevated bilirubin/alkaline \nphosphatase (greater than LFT elevation), concerning for biliary \nobstruction. Admission labs notable for bilirubin of 3.1, alk \nphos 2285, AST 154, ALT 180. ERCP and Surgery were consulted in \nthe ED, with no necessary acute surgical intervention needed. US \nof the abdomen comments on lack of portal vein flow, likely due \nto chronic portal vein thrombosis. CTA pancreas shows multiple \ncoarse pancreatic calcifications, and areas of irregular \nnarrowing and stricture, resulting in areas of pancreatic ductal \ndilatation, and moderate intra- and extra-hepatic biliary ductal \ndilatation. It also comments on 2 pancreatic head cystic \nlesions, likely c/w pseudocyts. Suspected biliary obstruction \nwas likely due to strictures related to pts chronic \npancreatitis. Pt was treated with IV dilaudid for pain, changed \nto oral once tolerating po. EUS was performed to further \nevaluate biliary tree and pancreatic cysts. This showed \nhypoechoic pancreatic parenchyma with stranding, calcification \nand lobularity. Also noted irregular Pancreatic duct, evolving \npancreatic head pseudocyst, proximal CBD dilation with smooth \ndistal taper, and changes of chronic pancreatitis. Gallbladder \nsludge and microlithiasis, tiny amount of CBD sludge were noted. \nIt was felt that patient should have a repeat EUS in ___ weeks \nto reassess the pancreatic parenchyma for any masses/malignancy \nas the pancreas was too inflamed at this time to fully assess \nfor masses. In addition, the sludge in the CBD and gallbladder \nwere felt to be either due to NPO/poor po intake recently vs. a \npossible etiology of her pancreatitis flare. ERCP service \nrecommended surgical evaluation for cholecystectomy after \ndischarge. On day of discharge and day prior to discharge, pt \nwas tolerating a regular diet, walking outside to smoke, and \ntolerating po dilaudid for pain. Social work saw pt prior to \ndischarge to offer alcohol cessation programs. The patient is \nnot interested in cessation of her drinking at this time, but \nhas cut back on her drinking recently as much as she feels she \ncan given financial/social stressors. LFTs on day of discharge: \nALT 120, AST, 164, Alk Phos 2611, Total Bili 1.9, Lipase 9. \nAgain, needs outpatient repeat EUS/GI follow up, as well as \nsurgical evaluation for cholecystectomy. Needs LFTs trended \n(likely will take several weeks to fall).\n.\n# Chronic portal vein/splenic vein occlusion: Pt noted to have \ncavernous transformation of the portal vein, and multiple \nsplenorenal and gastric varices as well. CT and US do not \ncomment on presence of cirrhosis. Most likely these occlusions \nare due to chronic pancreatitis. No intervention needed\n.\n# Gastric varices: Noted on CT scan. Likely due to splenic vein \nocclusion.\n.\n# Type 2 DM, controlled, no complications: Gave ___ dose Lantus \nand insulin while here.', 'medications_prescribed': ['1. Lantus 100 unit/mL Solution Sig: Thirty (30) units \nSubcutaneous at bedtime. ', '2. Insulin Lispro 100 unit/mL Solution Sig: One (1) unit \nSubcutaneous as directed: By your sliding scale. ', '3. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*20 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 54, 'gender': 'F', 'symptoms': 'Rib fractures', 'medical_history': ['hepatitis C', 'polysubstance abuse (including heroin)', 'ETOH abuse (prior to arrest, 5 pints of vodka a day)', 'tobacco abuse'], 'family_history': 'Non-contributory', 'present_illness': 'Mr. ___ is a ___ man with PMH of polysubstance \nabuse, hepatitis C (untreated), who presents as a transfer from \n___ for further evaluation after sustaining multiple rib \nfractures following CPR performed after an opioid overdose. \n\nThe patient is currently an incarcerated inmate, recently \narrested and sent back to prison 5 months after completing a ___ \nyear sentence. He was found to be down in his cell after he had \nsnorted a line of fentanyl. He was down for unknown period. CPR \nwas initiated and given for approximately 10 minutes before he \nwas given intranasal narcan during the event and reportedly \nregained consciousness. It is not clear if he ever actually loss \na pulse, although patient has no memory of being down or being \nawake while receiving CPR. He was initially brought to \n___ sometime prior to 11pm per the limited OSH records. \nHe underwent a chest CT that demonstrated bilateral rib \nfractures, [R 2, 3(displaced); L 3,4,5,6(displaced)], trace \npericardial effusion, and evidence of aspiration. Given the \nextent of his injuries, he was sent to ___ for trauma surgery \nevaluation. During the transport the patient became increasingly \nhypoxemic, and was placed back on a non-rebreather prior to \narrival. \n\nIn the ED, initial vitals: T 97.3, HR 86 BP 130/86 RR 16, 97% \non NRB\nTrauma exam notable for: CTA ___ with moderate to full \ninspiratory effort but diminished at bases; pain with palpation \nalong anterior chest wall, chest is stable. \n\n- Labs notable for:\n - WBC 14.6, Hg 13.3, plt 247\n - Na 138, K 4.7, bicarb 26, Cr 1.0\n - vbg not obtained\n - utox not obtained \n\n- Imaging notable for: \n - CXR: Hypoinflated lungs with retrocardiac opacities, likely\n atelectasis.\n - CT at ___: (refer to paper chart for report) \n \n- Pt given: Gabapentin 600mg; oxycodone 5mg; acetaminophen 1000 \nmg. \n \n- Trauma Surgery was consulted and recommended: \n - "admission to medicine post-arrest for pain control, \npulmonary \n toilet, and oxygen wean and social work consult for\n polysubstance use. No indication for trauma surgery \nadmission."\n\n- Vitals prior to transfer: T97.8, HR 98, BP 133/95, RR 17, 98% \non 4L.\n \nUpon arrival to the floor, the patient reports that in the 5 \nmonths that he was out of prison he had 5 OD\'s requiring Narcan. \nHe states that he desires to stop using.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'MRX1:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '580', 'valuenum': 580.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/12.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 209.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 36.0, 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'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '322', 'valuenum': 322.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '316', 'valuenum': 316.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\n===============\nVITALS: 98.2PO 136 / 92 80 16 95 5L \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclerae anicteric, MMM, oropharynx clear, EOMI, PERRL, \nFace assymetric but not different from prior baseline (admitted \nto prior episodes of facial trauma) neck supple, JVP not \nelevated, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, but shallow breaths \ndue to pain. no wheezes, rales, rhonchi \nChest wall: No deformity, but exquisitely tender.\nAbdomen: Soft, non-tender, non-distended, bowel sounds present, \nno organomegaly, no rebound or guarding \nGU: No foley \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSkin: Warm, dry, no rashes or notable lesions. \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally.\n\nDISCHARGE EXAM:\n===============\nVITALS: Temp: 98.4 (Tm 98.4), BP: 119/78 (116-142/78-91), HR: 89\n(73-89), RR: 18 (___), O2 sat: 93% (92-95), O2 delivery: 3L \nGeneral: Appears uncomfortable though more alert and cooperative\nwith exam compared to yesterday.\nHEENT: Sclerae anicteric, MMM, oropharynx clear, EOMI, PERRL,\nFace assymetric but not different from prior baseline (admitted\nto prior episodes of facial trauma) neck supple\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,\ngallops \nLungs: Clear to auscultation bilaterally on anterior exam, but\nshallow breaths due to pain. No wheezes, rales, rhonchi. Unable\nto examined posterior lung fields due to pain.\nChest wall: No obvious deformity, no ecchymosis. Exquisitely\ntender to light palpation.\nAbdomen: Soft, non-tender, non-distended, bowel sounds present,\nno organomegaly, no rebound or guarding \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or\nedema \nSkin: Warm, dry, no rashes or notable lesions. \nNeuro: CNII-XII intact, ___ strength upper/lower extremities,\ngrossly normal sensation', 'diagnoses': [{'icd_code': '1911', 'desc': 'Malignant neoplasm of frontal lobe'}, {'icd_code': '3229', 'desc': 'Meningitis, unspecified'}, {'icd_code': '3484', 'desc': 'Compression of brain'}, {'icd_code': '99859', 'desc': 'Other postoperative infection'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V153'}, {'icd_code': '4373', 'desc': 'Cerebral aneurysm, nonruptured'}], 'summary': "___ 11:40AM GLUCOSE-95 UREA N-24* CREAT-1.0 SODIUM-138 \nPOTASSIUM-4.7 CHLORIDE-96 TOTAL CO2-26 ANION GAP-16\n___ 11:40AM estGFR-Using this\n___ 11:40AM WBC-14.6* RBC-4.63 HGB-13.3* HCT-41.2 MCV-89 \nMCH-28.7 MCHC-32.3 RDW-14.6 RDWSD-46.3\n___ 11:40AM NEUTS-87.7* LYMPHS-6.8* MONOS-5.0 EOS-0.0* \nBASOS-0.2 IM ___ AbsNeut-12.84* AbsLymp-0.99* AbsMono-0.73 \nAbsEos-0.00* AbsBaso-0.03\n___ 11:40AM PLT COUNT-247\n\nINTERVAL LABS:\n==============\n___ 11:49PM BLOOD Glucose-82 UreaN-23* Creat-1.4* Na-140 \nK-3.8 Cl-102 HCO3-30 AnGap-8*\n___ 06:12AM BLOOD ALT-50* AST-33 LD(LDH)-347* AlkPhos-52 \nTotBili-0.3\n___ 06:12AM BLOOD HBsAg-NEG HBsAb-NEG HBcAb-NEG\n___ 07:55AM BLOOD Hapto-155\n___ 06:12AM BLOOD HIV Ab-NEG\n___ 06:12AM BLOOD HCV Ab-POS*\n___ 12:26AM BLOOD ___ pO2-47* pCO2-62* pH-7.31* \ncalTCO2-33* Base XS-2\n___ 06:12AM BLOOD HIV Ab-NEG\n\nDISCHARGE LABS:\n===============\n___ 05:37AM BLOOD WBC-6.3 RBC-4.23* Hgb-11.9* Hct-38.1* \nMCV-90 MCH-28.1 MCHC-31.2* RDW-14.3 RDWSD-47.1* Plt ___\n___ 05:37AM BLOOD Glucose-111* UreaN-12 Creat-1.2 Na-140 \nK-4.2 Cl-100 HCO3-30 AnGap-10\n___ 05:37AM BLOOD Calcium-8.7 Phos-3.6 Mg-2.1\n\nIMAGING:\n========\n\nCXR ___\n\nEXAMINATION: Chest radiograph \n \nINDICATION: History: ___ with desat// assess for ptx \n \nTECHNIQUE: Chest PA and lateral \n \nCOMPARISON: None. \n \nFINDINGS: \n \nLung volumes appear low. Mild retrocardiac opacities likely \nrepresent \natelectasis. There is no pulmonary edema, pneumothorax, or \npleural effusion. The cardiomediastinal silhouette is \naccentuated by low lung volumes but likely normal. \n \nIMPRESSION: \n \nHypoinflated lungs with retrocardiac opacities, likely \natelectasis. \n\nCXR ___\n\nTECHNIQUE: AP portable chest radiograph \n \nCOMPARISON: ___\n \nFINDINGS: \n \nThere are low bilateral lung volumes. Increased opacities at \nthe left lung base may reflect atelectasis or pneumonia. None \nlinear atelectasis is also present in the right midlung. There \nis no pleural effusion or pneumothorax identified. The size of \nthe cardiac silhouette is enlarged but may be magnified \nsecondary to the low lung volumes. \n \nIMPRESSION: \n \nIncreased retrocardiac opacities may reflect atelectasis however \ngiven the \nprovided clinical history, aspiration/pneumonia cannot entirely \nbe excluded.\nPATIENT SUMMARY:\n================ \n___ with PMH of polysubstance abuse, hepatitis C (unknown \ntreatment status), who presented as a transfer from ___ \nfor further evaluation after sustaining multiple rib fractures \nfollowing CPR performed after an opioid overdose. \n\nACUTE PROBLEMS: \n===============\n# Acute Respiratory Failure\n# Bilateral rib fractures\n# Pain control\nPatient found to be down in his cell after he had snorted a line \nof fentanyl. He was down for unknown period. CPR\nwas initiated and given for approximately 10 minutes before he \nwas given intranasal narcan during the event and reportedly \nregained consciousness. It is not clear if he ever actually loss \na pulse, although patient has no memory of being down or being \nawake while receiving CPR. He was initially brought to \n___ sometime prior to 11pm per the limited OSH records. \nHe underwent a chest CT that demonstrated bilateral rib \nfractures, [R 2,3(displaced); L 3,4,5,6(displaced)], trace \npericardial effusion, and evidence of aspiration. Given the \nextent of his injuries, he was sent to ___ for trauma surgery \nevaluation. Likely hypercarbic respiratory failure due to poor \nventilation with splinting from rib fractures. No evidence of \nflail chest. No evidence of pulmonary contusion or pneumothorax \nor cardiomegaly suggesting traumatic pericardial effusion on \nrepeat CXR. Patient with normal to increased RR and do not \nsuspect lingering overdose. Retrocardiac opacities on CXR likely \nrepresents atelectasis, in setting of decreased tidal volumes \nfrom pain. The patient's respiratory status gradually improved \nand he was weaned off of supplemental oxygen. Encouraged \nincentive spirometry. Pain controlled with reduced dose \ngabapentin (due to sedation, as per below), lidocaine patch, and \nstanding Tylenol. The patient was also initially on PRN \noxycodone which was changed to PRN tramadol based on sedation. \n\n# Somnolence\nPatient intermittently somnolent during this hospitalization. \nUnclear etiology. Likely related to high dose Seroquel, \ndiazepam, and high dose gabapentin. Cannot exclude intra-axial \netiologies, particularly after having been found down. . \nHypercarbia another possibility given small tidal volumes ___ \nchest pain. VBG obtained prior to admission was overall \nreassuring with PCO2 of 48 (compared to 62 on admission). \nSedating medications were downtitrated as per above. \n\n# Small pericardial effusion\nNoted on CT Chest at OSH. There was concern for tamponade at \nthis given episodic hypotension but bedside echocardiogram \nshowed only a trivial anterior effusion with no evidence of \nhemodynamic compromise. BPs improved by the time of discharge. \n\n# Risk for EtOH withdrawal\nRecent heavy drinking history was being treated with librium at \nprison for withdrawal for unclear duration. High risk\nfor withdrawal. Maintained initially on CIWA protocol with \nDiazepam. This was then discontinued due to somnolence. \n\n# Opioid Use Disorder\nUnclear what resources are available to the patient in prison. \nSocial work was consulted.\n\n# ___\nCreatinine peaked at 1.4 then improved to 1.2 at the time of \ndischarge. Likely pre-renal in the setting of poor PO intake. \n\nCHRONIC/STABLE PROBLEMS: \n========================\n# Tobacco use\nOffered patient nicotine patch. \n\n# History of Hepatitis C \nUnclear if cleared or previously treated. HCV Ab positive. HCV \nviral load pending at time of discharge. HIV screen negative. "}}
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{'final_diagnoses': ['Multiple rib fractures', 'Opioid overdose', 'HCV', 'Polysubstance use disorder', 'EtOH use disorder', 'Tobacco use disorder'], 'procedures': ['NONE'], 'visit_summary': "PATIENT SUMMARY:\n================ \n___ with PMH of polysubstance abuse, hepatitis C (unknown \ntreatment status), who presented as a transfer from ___ \nfor further evaluation after sustaining multiple rib fractures \nfollowing CPR performed after an opioid overdose. \n\nACUTE PROBLEMS: \n===============\n# Acute Respiratory Failure\n# Bilateral rib fractures\n# Pain control\nPatient found to be down in his cell after he had snorted a line \nof fentanyl. He was down for unknown period. CPR\nwas initiated and given for approximately 10 minutes before he \nwas given intranasal narcan during the event and reportedly \nregained consciousness. It is not clear if he ever actually loss \na pulse, although patient has no memory of being down or being \nawake while receiving CPR. He was initially brought to \n___ sometime prior to 11pm per the limited OSH records. \nHe underwent a chest CT that demonstrated bilateral rib \nfractures, [R 2,3(displaced); L 3,4,5,6(displaced)], trace \npericardial effusion, and evidence of aspiration. Given the \nextent of his injuries, he was sent to ___ for trauma surgery \nevaluation. Likely hypercarbic respiratory failure due to poor \nventilation with splinting from rib fractures. No evidence of \nflail chest. No evidence of pulmonary contusion or pneumothorax \nor cardiomegaly suggesting traumatic pericardial effusion on \nrepeat CXR. Patient with normal to increased RR and do not \nsuspect lingering overdose. Retrocardiac opacities on CXR likely \nrepresents atelectasis, in setting of decreased tidal volumes \nfrom pain. The patient's respiratory status gradually improved \nand he was weaned off of supplemental oxygen. Encouraged \nincentive spirometry. Pain controlled with reduced dose \ngabapentin (due to sedation, as per below), lidocaine patch, and \nstanding Tylenol. The patient was also initially on PRN \noxycodone which was changed to PRN tramadol based on sedation. \n\n# Somnolence\nPatient intermittently somnolent during this hospitalization. \nUnclear etiology. Likely related to high dose Seroquel, \ndiazepam, and high dose gabapentin. Cannot exclude intra-axial \netiologies, particularly after having been found down. . \nHypercarbia another possibility given small tidal volumes ___ \nchest pain. VBG obtained prior to admission was overall \nreassuring with PCO2 of 48 (compared to 62 on admission). \nSedating medications were downtitrated as per above. \n\n# Small pericardial effusion\nNoted on CT Chest at OSH. There was concern for tamponade at \nthis given episodic hypotension but bedside echocardiogram \nshowed only a trivial anterior effusion with no evidence of \nhemodynamic compromise. BPs improved by the time of discharge. \n\n# Risk for EtOH withdrawal\nRecent heavy drinking history was being treated with librium at \nprison for withdrawal for unclear duration. High risk\nfor withdrawal. Maintained initially on CIWA protocol with \nDiazepam. This was then discontinued due to somnolence. \n\n# Opioid Use Disorder\nUnclear what resources are available to the patient in prison. \nSocial work was consulted.\n\n# ___\nCreatinine peaked at 1.4 then improved to 1.2 at the time of \ndischarge. Likely pre-renal in the setting of poor PO intake. \n\nCHRONIC/STABLE PROBLEMS: \n========================\n# Tobacco use\nOffered patient nicotine patch. \n\n# History of Hepatitis C \nUnclear if cleared or previously treated. HCV Ab positive. HCV \nviral load pending at time of discharge. HIV screen negative. ", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H', 'Gabapentin 300 mg PO TID Duration: 2 Weeks \nStart after completing 2 weeks at 600 mg TID', 'Lidocaine 5% Patch 1 PTCH TD QPM', 'TraMADol 50 mg PO Q4H:PRN Pain - Severe Duration: 1 Week', 'Gabapentin 600 mg PO TID Duration: 2 Weeks', 'QUEtiapine Fumarate 400 mg PO QHS', 'Venlafaxine 150 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'M', 'symptoms': 'fall', 'medical_history': ['-DM ', '-Dyslipidemia', '-HTN', '-Depression', '-Ulcerative colitis (questionable), Saw Dr. ___ in ___, last \n___ at ___ ___ with normal biopsies', '-ESRD '], 'family_history': 'father w stroke', 'present_illness': '___ PMH ESRD ___ DM2, HTN on HD MWF, HLD, depression, UC, who \npresents after a mechanical fall. \n\nOf note, he was admitted to ___ in ___ after falling down \n3 stairs in the setting of dizziness. Had been having multiple \nsimilar episodes of dizziness and falls. Syncope workup included \nnegative orthostatics, unrevealing TTE, negative infectious \nworkup, negative Ct torso/head/C-spine. Home gabapentin, \ntorsemide, and metoprolol were held given concern that they \ncould be contributing to syncopal episodes. Pt left AMA before \ncompletion of workup.\n\nToday, pt reports that he tripped and fell on the sidewalk with \nhead, chest, and R knee strike. Denies LOC. Did not feel dizzy \nbeforehand. Was able to ambulate independently immediately \nafterwards. Called for EMS given worsening pain. Reported R \nknee, significant headache, and blurry vision on arrival to the \nED.\n\n- In the ED, initial vitals were: afebrile, HR 80, BP 164/92, RR \n16, satting mid ___ on RA\n\n- Exam was notable for: 2cm abrasion to R forehead, PERRLA, \nEOMI, unremarkable otoscopic exam, tenderness to palpation at \nC-spine and L-spine and T3/T4 spinous process, abrasion to R \nknee with tenderness to palpation, no focal neurologic deficits\n\n- Labs were notable for: Hgb 11.6, Na 130, K 7.9 (hemolyzed) -> \n6.0 (whole blood, hemolyzed) -> 5.5 (whole blood) after 10U IV \ninsulin, bicarb 19, anion gap 14, glucose 472. \n\n- Studies were notable for:\n-- CXR w/ mild prominence of the central pulmonary vasculature \nwithout evidence of overt edema\n-- XR pelvis and R knee without acute process\n-- XR R hand demonstrating fracture of R ___ middle phalanx\n-- CT head and C-spine without fracture or acute process\n\n- The patient was given: 650mg PO acetaminophen x2, 10U IV \ninsulin for hyperkalemia, atorvastatin 40mg, amitriptyline 25mg, \nparoxetine 20mg Tdap booster. He did not receive any SC insulin.\n\n- Renal dialysis service consulted, cleared for discharge from \nrenal perspective given non-hemolyzed K < 6 and arrangements \nthat had been made for outpatient HD tomorrow morning.\n\n- Admitted for hyperglycemia. FSBG 191 on arrival to the floor.\n\nOn arrival to the floor, he shares that he is most bothered by \npain on his left forehead, left posterior neck, and R ___ finger \nthat he attributes to the fall. Also endorses R knee pain and \nthe sensation that multiple left lower jaw teeth are loose from \nhis fall. He shares that he fell around noon today, denies any \ndizziness or lightheadedness prior to the fall today, says he \nsimply tripped on the uneven sidewalk. Does not think he lost \nconsciousness at any point but felt dizzy and had some blurry \nvision after the fall which has now resolved. Had a headache and \nback pain which improved with acetaminophen in the ED. Denies \nfever/chills, N/V, chest pain, palpitations, SOB. \n\nPt denies recent changes in his health or medications. He and \nhis wife at bedside do not remember the names and doses of his \nmedications. He shares that his home insulin dose is 30U \nglargine every morning but he is unable to administer it to \nhimself. He used to have a ___ who helped administer insulin, \nbut lately has not had a nurse so only receives insulin when his \nwife visits. They live separately and she comes to his home \nabout once a week. Per wife, his fasting morning BG is typically \nin the 100s.\n\nREVIEW OF SYSTEMS:\n==================\nPer HPI, otherwise, 10-point review of systems was within normal \nlimits.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Fludrocortisone Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Propranolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.026', 'valuenum': 1.026, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCC.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 152.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '552', 'valuenum': 552.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.95', 'valuenum': 3.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 193.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Negative.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.029', 'valuenum': 0.029, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 171.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nVITALS: ___ 2118 Temp: 97.5 PO BP: 184/84 L Lying HR: 70 \nRR:\n18 O2 sat: 92% O2 delivery: Ra \nGENERAL: Alert and interactive. Sitting in bed in no acute\ndistress.\nHEENT: Dried blood and 3-4cm oval area of edema on left \nforehead,\ntender to palpation. PERRL, EOMI. Sclera anicteric. MMM. \nMultiple\nmissing teeth.\nNECK: L posterior neck diffusely tender to palpation. No \ncervical\nlymphadenopathy.\nCARDIAC: RRR, normal S1/S2, no m/r/g.\nLUNGS: CTAB. No wheezes, rhonchi or rales. No increased work of\nbreathing.\nABDOMEN: Normal bowels sounds, soft, non-distended, non-tender \nto\ndeep palpation in all four quadrants. No organomegaly.\nEXTREMITIES: 2-3cm abrasion on R anterior knee with tenderness \nto\npalpation. R ___ digit with moderate swelling and tenderness to\npalpation between PIP and DIP joints. RUE AVF +thrill, bruit.\nSKIN: WWP. No rashes.\nNEUROLOGIC: AOx3. CN2-12 intact. Moving all 4 limbs\nspontaneously. ___ strength throughout. Sensation to light touch\nintact.\n\nDISCHARGE PHYSICAL EXAM:\n========================\nVitals: \n24 HR Data (last updated ___ @ 1303)\n Temp: 98.0 (Tm 98.7), BP: 162/89 (148-190/79-104), HR: 84 \n(69-84), RR: 16 (___), O2 sat: 96% (93-97), O2 delivery: Ra, \nWt: 170.63 lb/77.4 kg \n\nGENERAL: Alert and interactive. Sitting in bed in no acute\ndistress.\nHEENT: Mild abrasion on forehead, now dried without active \nbleeding. PERRL, EOMI. Sclera anicteric. MMM. Multiple\nmissing teeth.\nCARDIAC: RRR, normal S1/S2, no m/r/g.\nLUNGS: CTAB. No wheezes, rhonchi or rales. No increased work of\nbreathing.\nABDOMEN: Normal bowels sounds, soft, non-distended, non-tender \nto\ndeep palpation in all four quadrants. No organomegaly.\nEXTREMITIES: 2-3cm abrasion on R anterior knee with mild \ntenderness to palpation. R ___ digit, mild tenderness to \npalpation between PIP and DIP joints. RUE AVF +thrill, bruit.\nSKIN: WWP. No rashes.\nNEUROLOGIC: AOx3. CN2-12 intact. Moving all 4 limbs \nspontaneously. ___ strength throughout. Sensation to light touch\nintact.', 'diagnoses': [{'icd_code': 'S066X0A', 'desc': 'Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'G40909', 'desc': 'Epilepsy, unspecified, not intractable, without status epilepticus'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I6521', 'desc': 'Occlusion and stenosis of right carotid artery'}, {'icd_code': 'W010XXA', 'desc': 'Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'S42031A', 'desc': 'Displaced fracture of lateral end of right clavicle, initial encounter for closed fracture'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'R339', 'desc': 'Retention of urine, unspecified'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'Z85118', 'desc': 'Personal history of other malignant neoplasm of bronchus and lung'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}], 'summary': 'ADMISSION LABS:\n==================\n___ 02:30PM BLOOD WBC-5.5 RBC-4.11* Hgb-11.6* Hct-36.3* \nMCV-88 MCH-28.2 MCHC-32.0 RDW-14.7 RDWSD-46.5* Plt ___\n___ 02:30PM BLOOD Neuts-69.5 ___ Monos-7.9 Eos-1.8 \nBaso-0.5 Im ___ AbsNeut-3.80 AbsLymp-1.05* AbsMono-0.43 \nAbsEos-0.10 AbsBaso-0.03\n___ 02:30PM BLOOD Glucose-472* UreaN-39* Creat-9.6*# \nNa-130* K-7.9* Cl-97 HCO3-19* AnGap-14\n___ 02:30PM BLOOD Calcium-8.3* Phos-5.0* Mg-1.8\n\nDISCHARGE LABS:\n==================\n___ 06:50AM BLOOD WBC-5.7 RBC-4.17* Hgb-11.7* Hct-35.6* \nMCV-85 MCH-28.1 MCHC-32.9 RDW-14.6 RDWSD-45.4 Plt ___\n___ 06:50AM BLOOD Glucose-157* UreaN-24* Creat-6.6*# Na-137 \nK-4.5 Cl-96 HCO3-23 AnGap-18\n___ 06:50AM BLOOD Calcium-8.3* Phos-4.5 Mg-1.8\n\nIMAGING/RESULTS:\n===================\nRIGHT HAND ___:\nAvulsion fracture at the volar base of the mid phalanx of the \npinky finger \nwith overlying soft tissue swelling. Bones are demineralized \ndiffusely. \n\nCT HEAD W/O CONTRAST ___:\nNo acute intracranial process.\n\nCT C-SPINE ___:\nNo evidence of traumatic cervical malalignment or acute \nfracture.\n\nCXR ___:\n1. Mild prominence of the central pulmonary vasculature without \nevidence of overt edema. \n2. No displaced rib fractures seen. \n\nR KNEE ___:\nNo acute fracture or dislocation. \n\nPELVIS PLAIN FILMS ___:\nNo evidence of acute fracture on this single AP view of the \npelvis.\nASSESSMENT/PLAN:\n___ PMH ESRD ___ DM2, HTN on HD MWF, HLD, depression, UC, who \npresents following a mechanical fall, found to have close \nfracture of R ___ finger, now splinted, and mild hyperkalemia \nand hyperglycemia, now resolved. \n\nACUTE/ACTIVE ISSUES:\n====================\n# s/p mechanical fall\n# R ___ finger fracture\nPt has a history of dizziness and falls for which he was \nadmitted in ___, negative workup including TTE. He presents \ntoday after a mechanical fall, denies any dizziness or syncope. \nNo acute process on CT head or C-spine. No acute process on XR \nof R knee and pelvis. Found to have closed R ___ middle phalanx \nfracture, now placed in splint by hand surgery. Endorses \nposterior L neck pain, likely ___ muscle strain w/ negative CT \nimaging. Headache and back pain improving with APAP, blurry \nvision resolved. Potentially may require surgery in future but \nnot necessary inpatient, appointment 1230pm ___ w/ BI hand \nsurgery (also noted that if this does not work he can f/u with \nDr. ___ anytime on ___. Per hand \nsurgery: immobilization in flexion of the PIP at 30 degrees and \nfinger splint. Please do not remove splint. Pain control with \nAPAP 1000mg TID, lidocaine patch at L neck.\n\n# T2DM\n# Hyperglycemia\nPresented with BG > 400 in the setting of not receiving insulin \ntoday. No acidosis. His home regimen is 30U glargine QAM. Pt is \nnot able to administer insulin himself, previously had a ___ but \nhas not had one recently. His wife gives him insulin when she \nvisits, average 1x per week. Per wife, his fasting BG levels in \nthe morning are usually in the 100s. Pt will not be checking \nblood glucose at home, goal is to get him daily insulin at a \nminimum. Arranged for ___ after discharge, as well as informal \nteaching with pt and family on importance of daily insulin \nregimen to control glucose levels. Continue home glargine 30U \nQAM.\n\n# ESRD on HD\n# Hyperkalemia\nHistory of ESRD ___ DM and hypertension, on ___ HD. Renal \nconsulted in the ED for hemolyzed K of 7.9, most recently whole \nblood 5.5. Asymptomatic, no ECG changes. Likely hyperkalemic due \nto missing HD ___. Received HD ___. We trended \npotassium while inpatient.\n\n# Hypertension\n# Volume\nSBP 180s, asymptomatic. Likely ___ missing HD and home \nanti-hypertensives today. However, unclear how often he is \ntaking home meds due to last refills being early ___ and \npatient unaware of when to take. Appears euvolemic on exam. \nReceived HD today as above. Continued home amlodipine 10mg QD \nand torsemide 10mg QD. Followed 1.5L fluid restriction per \nRenal. Recommend PCP followup for chronic HTN management and f/u \nfor adherence.\n\nCHRONIC/STABLE ISSUES:\n======================\n# Depression\nHistory of depression for which he is on disability. Continued \nhome paroxetine, amitryptiline. Held PRN trazadone.\n\n# Other home medications\nContinued home omeprazole 20mg QD, atorvastatin 40mg QD, vitamin \nB12. Held home gabapentin, metoprolol as these were discontinued \nduring last admission in ___ (concern for contribution to \ndizziness/syncope).\n\n# Chronic normocytic anemia\nLikely ___ CKD. Admission Hgb 11.6 from 9 in ___ and \n___. Received Epogen and Fe with HD.\n\nTRANSITIONAL ISSUES:\n========================\n[] Needs additional DM education as outpatient\n[] Ensure understanding of how to take insulin at next office \nvisit\n[] Uptitrate anti-HTN as tolerated - restarted on amlodipine and \ntorsemide\n[] Consider additional work up of his falls - extensive work up \nduring last hospitalization negative\n[] Concerned about medication compliance\n[] Needs to wear splint daily until seen in hand clinic - either \nat ___ on ___ at 12:30pm or anytime on ___ with \nDr. ___ \n___'}}
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{'final_diagnoses': ['Fall - R ___ phalanx fracture and hyperglycemia'], 'procedures': ['None - splint placed of R ___ finger by ortho.'], 'visit_summary': 'ASSESSMENT/PLAN:\n___ PMH ESRD ___ DM2, HTN on HD MWF, HLD, depression, UC, who \npresents following a mechanical fall, found to have close \nfracture of R ___ finger, now splinted, and mild hyperkalemia \nand hyperglycemia, now resolved. \n\nACUTE/ACTIVE ISSUES:\n====================\n# s/p mechanical fall\n# R ___ finger fracture\nPt has a history of dizziness and falls for which he was \nadmitted in ___, negative workup including TTE. He presents \ntoday after a mechanical fall, denies any dizziness or syncope. \nNo acute process on CT head or C-spine. No acute process on XR \nof R knee and pelvis. Found to have closed R ___ middle phalanx \nfracture, now placed in splint by hand surgery. Endorses \nposterior L neck pain, likely ___ muscle strain w/ negative CT \nimaging. Headache and back pain improving with APAP, blurry \nvision resolved. Potentially may require surgery in future but \nnot necessary inpatient, appointment 1230pm ___ w/ BI hand \nsurgery (also noted that if this does not work he can f/u with \nDr. ___ anytime on ___. Per hand \nsurgery: immobilization in flexion of the PIP at 30 degrees and \nfinger splint. Please do not remove splint. Pain control with \nAPAP 1000mg TID, lidocaine patch at L neck.\n\n# T2DM\n# Hyperglycemia\nPresented with BG > 400 in the setting of not receiving insulin \ntoday. No acidosis. His home regimen is 30U glargine QAM. Pt is \nnot able to administer insulin himself, previously had a ___ but \nhas not had one recently. His wife gives him insulin when she \nvisits, average 1x per week. Per wife, his fasting BG levels in \nthe morning are usually in the 100s. Pt will not be checking \nblood glucose at home, goal is to get him daily insulin at a \nminimum. Arranged for ___ after discharge, as well as informal \nteaching with pt and family on importance of daily insulin \nregimen to control glucose levels. Continue home glargine 30U \nQAM.\n\n# ESRD on HD\n# Hyperkalemia\nHistory of ESRD ___ DM and hypertension, on ___ HD. Renal \nconsulted in the ED for hemolyzed K of 7.9, most recently whole \nblood 5.5. Asymptomatic, no ECG changes. Likely hyperkalemic due \nto missing HD ___. Received HD ___. We trended \npotassium while inpatient.\n\n# Hypertension\n# Volume\nSBP 180s, asymptomatic. Likely ___ missing HD and home \nanti-hypertensives today. However, unclear how often he is \ntaking home meds due to last refills being early ___ and \npatient unaware of when to take. Appears euvolemic on exam. \nReceived HD today as above. Continued home amlodipine 10mg QD \nand torsemide 10mg QD. Followed 1.5L fluid restriction per \nRenal. Recommend PCP followup for chronic HTN management and f/u \nfor adherence.\n\nCHRONIC/STABLE ISSUES:\n======================\n# Depression\nHistory of depression for which he is on disability. Continued \nhome paroxetine, amitryptiline. Held PRN trazadone.\n\n# Other home medications\nContinued home omeprazole 20mg QD, atorvastatin 40mg QD, vitamin \nB12. Held home gabapentin, metoprolol as these were discontinued \nduring last admission in ___ (concern for contribution to \ndizziness/syncope).\n\n# Chronic normocytic anemia\nLikely ___ CKD. Admission Hgb 11.6 from 9 in ___ and \n___. Received Epogen and Fe with HD.\n\nTRANSITIONAL ISSUES:\n========================\n[] Needs additional DM education as outpatient\n[] Ensure understanding of how to take insulin at next office \nvisit\n[] Uptitrate anti-HTN as tolerated - restarted on amlodipine and \ntorsemide\n[] Consider additional work up of his falls - extensive work up \nduring last hospitalization negative\n[] Concerned about medication compliance\n[] Needs to wear splint daily until seen in hand clinic - either \nat ___ on ___ at 12:30pm or anytime on ___ with \nDr. ___ \n___', 'medications_prescribed': ['1. Glargine 30 Units Breakfast\nRX *insulin glargine [Lantus Solostar U-100 Insulin] 100 unit/mL \n(3 mL) AS DIR 30 Units before BKFT; Disp #*1 Syringe Refills:*10 ', '2. Acetaminophen 500 mg PO Q8H ', '3. Amitriptyline 25 mg PO QHS \nRX *amitriptyline 25 mg 1 tablet(s) by mouth at bedtime Disp \n#*30 Tablet Refills:*0 ', '4. amLODIPine 10 mg PO DAILY \nRX *amlodipine 10 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*0 ', '5. Atorvastatin 40 mg PO QPM \nRX *atorvastatin 40 mg 1 tablet(s) by mouth QPM Disp #*30 Tablet \nRefills:*0 ', '6. Cyanocobalamin 25 mcg PO DAILY ', '7. Lidocaine-Prilocaine 1 Appl TP DAILY ', '8. Nephrocaps 1 CAP PO DAILY \nRX *B complex with C#20-folic acid [Nephrocaps] 1 mg 1 tab-cap \nby mouth once a day Disp #*30 Capsule Refills:*0 ', '9. Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*30 \nCapsule Refills:*0 ', '10. PARoxetine 20 mg PO DAILY \nRX *paroxetine HCl 20 mg 1 tablet(s) by mouth once a day Disp \n#*30 Tablet Refills:*0 ', '11. Torsemide 10 mg PO DAILY \nRX *torsemide 10 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*0 ', '12. HELD- Gabapentin 300 mg PO DAILY This medication was held. \nDo not restart Gabapentin until you see your PCP', '13. HELD- Metoprolol Succinate XL 50 mg PO DAILY This \nmedication was held. Do not restart Metoprolol Succinate XL \nuntil you see your PCP', '14. HELD- TraZODone 50 mg PO QHS:PRN sleep This medication was \nheld. Do not restart TraZODone until you see your PCP']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 59, 'gender': 'M', 'symptoms': 'fevers and leukocytosis', 'medical_history': ['DM Type 1 c/b retinopathy, nephropathy, neuropathy, and \ngastroparesis', 'CAD s/p CABG ___', 'Acute mitral regurgitation s/p MVR w/ biopros valve on ___', 'Severe orthostatic hypotension from autonomic neuropathy', 'Endometriosis', 'Hyperlipidemia', 'Hypertension'], 'family_history': 'Mother: HTN, ___\nFather: ___, CVA, CAD, MI\nNo history of malignancy', 'present_illness': '___ year old female with a past medical history notable for of \nType I diabetes mellitus, recent CABG and MVR in ___, \nrecent acute on chronic renal failure requiring dialysis who \npresented from rehab with worsening leukocytosis (18 on \n___ at rehab) and fevers. The patient states that she she \nis also being treated for pneumonia, UTI and right ear infection \nwith ertapenum. She complains of cough and wheezing however her \nSOB has improved and she is no longer requiring oxygen. The \npatient injured her knee with physical therapy on ___ and \ncontinues to experience knee pain. She has not orthopedic \nhardware.She has multiple foot ulcers as well as a right leg \nulcer which are painless. She denies headache, vision changes, \nchest pain, nausea, vomiting, diarrhea and lower extremity \nedema. \n\nRegarding her recent renal failure, the patient has not needed \ndialysis in >3 weeks. She is a patient of Dr. ___ \nlast creatinine at rehab was 1.4 on ___. Her last INR was \n2.4 on ___. She takes warfarin for pAF.', 'medications': [{'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Methadone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Clonidine Patch 0.1 mg/24 hr', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QTUES', 'doses_per_24_hrs': 0.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim SS', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ketamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim SS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lopinavir-Ritonavir', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lopinavir-Ritonavir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '211', 'valuenum': 211.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.6,. Estimated GFR = 45 if non African-American (mL/min/1.73 m2). Estimated GFR = 54 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 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'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '274', 'valuenum': 274.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'umol/L', 'ref_range_lower': 12.0, 'ref_range_upper': 47.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '831', 'valuenum': 831.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\nVitals- 99.1 136/57 82 22 100% RA\nGeneral- AAOx3, no acute distress, appears generally well, \ninteractive\nHEENT- cloudy right cornea w/ loss of vision, irregular left \npupil which is reactive to light, nose clear, OP w/o lesions\nNeck- no lymphadenopathy\nLungs- decreased air entry at the bases bilaterally w/ \nassoicated faint rales, no wheezes/rhonchi\nCV- RRR, soft systolic murmur at base, no rubs/gallops\nAbdomen- +BS, soft, non-tender, non-distended\nGU- not performed\nExt- WWP, trace symmetric ___ edema, right medial thigh ulcer \nwith fibrinous exudate w/o surrounding erythema, left knee with \nmild effusion w/o increased warmth/pain on passive ROM, \ndecreased sensation of BLE\nNeuro- ___ upper and lower extremity strenght bilaterally, other \nthan above noted left eye blinding CN II-XII intact\nLines- left midline w/o erythema/tenderness, right HD tunneled \ncatheter without superficial erythema/warmth\n\nDISCHARGE PHYSICAL EXAM\nVitals- 98.5 141/46 74 18 96/RA\nGeneral- Alert, oriented, no acute distress\nHEENT- cloudy right cornea w/ loss of vision, irregular left \npupil which is reactive to light, nose clear, OP w/o lesions \nNeck- no LAD\nLungs- CTAB, no wheezes, rales, ronchi\nCV- RRR, normal S1 and S2, no appreciable m/r/g\nAbdomen- soft, non-distended, bowel sounds present, no \ntenderness to palpation over the suprapubic region\nGU- no Foley\nExt- WWP, 2+ pitting edema to thigh on right, 1+ edema to shins \non left, ulcers on R medial thigh, R dorsal foot, L calcaneus \nall stable. BLE are sensitive to light palpation R>L \n(inconsistent during exam and stable over past several days). \nDecreased sensation of BLE.\nNeuro- A&Ox3, no asterixis', 'diagnoses': [{'icd_code': '57470', 'desc': 'Calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction'}, {'icd_code': '042', 'desc': 'Human immunodeficiency virus [HIV] disease'}, {'icd_code': '30401', 'desc': 'Opioid type dependence, continuous'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}, {'icd_code': '30560', 'desc': 'Cocaine abuse, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '29410', 'desc': 'Dementia in conditions classified elsewhere without behavioral disturbance'}, {'icd_code': '29690', 'desc': 'Unspecified episodic mood disorder'}, {'icd_code': '2971', 'desc': 'Delusional disorder'}], 'summary': "___ 06:38PM GLUCOSE-118* UREA N-35* CREAT-1.6* SODIUM-141 \nPOTASSIUM-4.1 CHLORIDE-102 TOTAL CO2-24 ANION GAP-19\n___ 06:38PM WBC-16.6* RBC-3.19* HGB-9.3* HCT-30.5* MCV-96 \nMCH-29.2 MCHC-30.5* RDW-16.3*\n___ 06:38PM NEUTS-82.6* LYMPHS-9.0* MONOS-7.5 EOS-0.6 \nBASOS-0.3\n___ 06:38PM PLT COUNT-413\n___ 06:24PM LACTATE-1.2\n___ 09:00PM URINE COLOR-Yellow APPEAR-Hazy SP ___\n___ 09:00PM URINE BLOOD-SM NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-LG\n___ 09:00PM URINE RBC-25* WBC->182* BACTERIA-FEW \nYEAST-MANY EPI-28 RENAL EPI-1\n___ 09:00PM URINE HYALINE-7*\n___ 09:00PM URINE WBCCLUMP-FEW\n\n___ EKG\nBaseline artifact. Sinus rhythm. Low limb lead voltage. RSR' \npattern \nin leads V1-V2. Early R wave progression. Non-diagnostic \ninferior Q waves. Since the previous tracing of ___ the \nrate is slower. Otherwise, no change. \n\n___ CXR\nIMPRESSION: \n1. Cardiomegaly. \n2. Bibasilar opacities on the left could be due to pleural \neffusion and \natelectasis, although consolidation due to infection is not \nexcluded at either lung base. \n\n___ LEFT KNEE X-RAY\nFindings: No evidence of acute fracture dislocation is seen. \nTiny posterior patellar spur are noted. No concerning \nosteoblastic or lytic lesion is seen. There is a moderate to \nlarge suprapatellar joint effusion. Extensive vascular \ncalcifications are seen. \nIMPRESSION: \nModerate to large suprapatellar joint effusion without \nunderlying fracture seen. \n\n___ TTE\nThe left atrium is normal in size. The estimated right atrial \npressure is ___ mmHg. Left ventricular wall thickness, cavity \nsize and regional/global systolic function are normal (LVEF \n>55%). The estimated cardiac index is normal (>=2.5L/min/m2). \nThe right ventricular cavity is mildly dilated with borderline \nnormal free wall function. There is abnormal diastolic septal \nmotion/position consistent with right ventricular volume \noverload. The aortic valve leaflets (?#) appear structurally \nnormal with good leaflet excursion. No masses or vegetations are \nseen on the aortic valve. There is no aortic valve stenosis. No \naortic regurgitation is seen. A bioprosthetic mitral valve \nprosthesis is present. The prosthetic mitral leaflets appear \nnormal. The motion of the mitral valve prosthetic leaflets \nappears normal. The gradients are higher than expected for this \ntype of prosthesis. No mass or vegetation is seen on the mitral \nvalve. Trivial mitral regurgitation is seen. [Due to acoustic \nshadowing, the severity of mitral regurgitation may be \nsignificantly UNDERestimated.] The tricuspid valve leaflets are \nmildly thickened. There is mild pulmonary artery systolic \nhypertension. No vegetation/mass is seen on the pulmonic valve. \nThere is a trivial/physiologic pericardial effusion. \n\nIMPRESSION: Well seated bioprosthetic mitral valve with mildly \nelevated transvalvular gradients. No echocardiographic evidence \nof endocarditis. Normal left ventricular cavity sizes with \npreserved global and regional systolic function. Borderline \nright ventricular systolic function. Mild pulmonary \nhypertension.\n\nCompared with the prior study (images reviewed) of ___, a \nbioprosthetic mitral valve is present. \n\n___ ART DUP EXT UP BILAT COMP\nIMPRESSION: Patent central veins. Bi/triphasic arterial flow \nwith small \nradial arteries and calcifications. The cephalic and basilic \nvein diameters as noted. \n\n___ VENOUS DUP UPPER EXT BILATERAL\nIMPRESSION: Patent central veins. Bi/triphasic arterial flow \nwith small \nradial arteries and calcifications. The cephalic and basilic \nvein diameters as noted. \n\n___ L FOOT X-RAY 1 VIEW\nThis exam consists of only a single cross-table lateral \nradiograph of the left foot. There is prominent bone \ndestruction involving most or all of the tarsal bones distal to \nthe talus and calcaneus with associated subluxations or \ndislocations particularly of the navicular bone. There is \nprominent dorsal soft tissue swelling. Vascular calcifications \nwith normal bone mineralization (consistent with diabetic \nneuropathy). Since previous relatively similar exam ___, the apparent ulceration over the posterior heel pad seen \nat that time is less evident and the dorsal soft tissue swelling \nis more prominent. No discrete or new focus of bone \ndestruction. \n \nIMPRESSION: Limited single view with findings typical of \ndiabetic neuropathic osteoarthropathy. \n\n___ RENAL ULTRASOUND\nFINDINGS: The left kidney measures 9.7 cm and there is no \nhydronephrosis, stone or mass. The right kidney measures 9.9 cm \nand there is no hydronephrosis, stone or mass. The bladder is \ncollapsed and not well seen. A few hyperechoic foci are seen in \nthe renal sinuses bilaterally likely representing either renal \nsinus fat or vascular calcifications. \n \nIMPRESSION: No evidence of hydronephrosis. No other \nabnormality identified. The bladder is collapsed and not well \nseen. \n\n___ VENOUS DUP EXT UNI (MAP/DVT) RIGHT\nImpression: No evidence of right lower extremity deep vein \nthrombosis.\n\n___ 09:25AM BLOOD WBC-8.4 RBC-2.92* Hgb-7.9* Hct-26.5* \nMCV-91 MCH-27.1 MCHC-29.9* RDW-16.4* Plt ___\n___ 09:25AM BLOOD Glucose-154* UreaN-31* Creat-1.4* Na-136 \nK-3.9 Cl-101 HCO3-27 AnGap-12\n___ 09:25AM BLOOD Calcium-8.5 Phos-3.6 Mg-2.0\n___ 09:25AM BLOOD ___ PTT-40.7* ___\n___ 09:23AM URINE Color-Yellow Appear-Hazy Sp ___\n___ 09:23AM URINE Blood-MOD Nitrite-NEG Protein-100 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG\n___ 09:23AM URINE RBC->182* WBC-79* Bacteri-FEW Yeast-MOD \nEpi-1 TransE-1\n\n*********MICRO**********\n___ 1:36 pm STOOL CONSISTENCY: NOT APPLICABLE\n Source: Stool. \n **FINAL REPORT ___\n C. difficile DNA amplification assay (Final ___: \n Reported to and read back by ___. ___ @ 10:52 AM ON \n___. \n CLOSTRIDIUM DIFFICILE. \n Positive for toxigenic C. difficile by the Illumigene \nDNA\n amplification. (Reference Range-Negative). \n\n___ 11:41 am URINE Source: Catheter. \n **FINAL REPORT ___\n URINE CULTURE (Final ___: \n YEAST. >100,000 ORGANISMS/ML..\n\n___ 9:23 am URINE Source: Catheter. \n URINE CULTURE (Preliminary): \n GRAM NEGATIVE ROD(S). 10,000-100,000 ORGANISMS/ML..\n___ year old female with a PMH of Type I diabetes mellitus, \nrecent CABG and tissue MVR in ___, recent acute on \nchronic renal failure requiring dialysis who presented from \nrehab with worsening leukocytosis (18 on ___ at rehab) and \nfevers, now with ___. \n\nACTIVE ISSUES:\n# Fevers: Patient was initially treated for UTI with Vanc/Zosyn \ngiven admission UA. She had serial urine cultures, one which \ngrew yeast (she received 1 dose of fluconazole) and another \nwhich grew out 10,000-100,000 GNRs. However, patient continued \nto develop fevers without significant improvement in her \nleukocytosis. Because she denied any dysuria symptoms, vanc and \nzosyn were stopped on ___. Her HD line was pulled, cath tip \nculture was negative. Her multiple ulcers were assessed by \nVascular Surgery and Podiatry, both of whom did not feel her \nulcers were infected. She had imaging of her feet which showed \nno areas of new osteomyelitis. At admission she also had a left \nknee pleural effusion and later developed pain in her right knee \nas well. Given her adequate passive ROM of knee flexion \nbilaterally, her exam was not consistent with septic arthritis. \nShe was seen by ortho who felt this was not a septic joint, \nrather inflammation from trauma. She was C.diff positive and \nstarted on PO vancomycin after which her leukocytosis and fevers \nresolved. She will continue PO vanc till 1.30.\n\n#Acute on chronic kidney disease: Patient became oliguric and \nhad Cr rise which peaked at 3.4. Urine sediment showed brown \nmuddy casts with urine eos, likely ATN vs AIN. Her Cr improved \nto baseline (1.4 at time of discharge) and she did not require \nHD and her urine output improved. She did become volume \noverloaded while she was oliguric and continues to have 1+ \npitting edema to her knees bilaterally. She was continued on \nher ___ Lasix 40 mg BID to which she has good response. She \nalso had bilateral upper extremity vein mapping in anticipation \nof future need for dialysis. She will have follow-up with her \noutpatient nephrologist. \n\n#Lower extremity pain: Edema likely ___ volume overload. Patient \ndeveloped some asymmetric pitting edema, R>L, but LENIs were \nnegative for DVT. She has pain to palpation in her BLE thought \nto be ___ volume overload, diabetic neuropathy. Her pain is not \nlocalized strictly in the joints. However, should she develop \nlocalized pain in her knees and passive ROM is completely \nlimited by pain, would consider checking a uric acid to assess \nfor gout. \n\n#DMI complicated by critical hypoglycemia, 40s. Patient \nevaluated by ___ who recommended Lantus 18u QAM + HISS. \nFSBGs well controlled while in-house in the 130s-240 range day \nprior to discharge.\n\n___ ulcers: The patient has multiple foot and lower extremity \nulcers with fibrinous exudates. None appeared to be actively \ninfected. Patient received ongoing wound care. The patient was \nevaluated by Vascular Surgery and Podiatry who did not think \nsurgical debridement was necessary. Patient has follow-up with \nPodiatry and Vascular Surgery.\n\n#Paroxysmal atrial fibrillation: Developed post op after CABG/ \ntissue valve surgery. Rate well controlled on ___ metoprolol. \nPatient was continued on her warfarin 2mg from rehab. However, \nshe became supratherapeutic so her coumadin was held. Her \ncoumadin was restarted, but then uptitrated to 3 mg qday after \nthe patient's subtherapeutic INR persisted. INR at discharge \nwas 2.1.\n\n*****TRANSITIONAL ISSUES*****\n- Code: full (confirmed)\n- Patient should have INR checked on ___. \n- If patient develops localized pain only in knee joint and \npassive ROM is completely limited by pain, can consider checking \na uric acid level. For now I would treat symptoms w/ tylenol"}}
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{'final_diagnoses': ['C. diff colitis', 'acute tubular necrosis/ ___', 'Diabetic foot ulcer', 'Right thigh pressure ulcer', 'Chronic kidney disease stage III', 'Type 1 diabetes mellitus, uncontrolled with complications', 'Diabetic neuropathy'], 'procedures': ['None'], 'visit_summary': "___ year old female with a PMH of Type I diabetes mellitus, \nrecent CABG and tissue MVR in ___, recent acute on \nchronic renal failure requiring dialysis who presented from \nrehab with worsening leukocytosis (18 on ___ at rehab) and \nfevers, now with ___. \n\nACTIVE ISSUES:\n# Fevers: Patient was initially treated for UTI with Vanc/Zosyn \ngiven admission UA. She had serial urine cultures, one which \ngrew yeast (she received 1 dose of fluconazole) and another \nwhich grew out 10,000-100,000 GNRs. However, patient continued \nto develop fevers without significant improvement in her \nleukocytosis. Because she denied any dysuria symptoms, vanc and \nzosyn were stopped on ___. Her HD line was pulled, cath tip \nculture was negative. Her multiple ulcers were assessed by \nVascular Surgery and Podiatry, both of whom did not feel her \nulcers were infected. She had imaging of her feet which showed \nno areas of new osteomyelitis. At admission she also had a left \nknee pleural effusion and later developed pain in her right knee \nas well. Given her adequate passive ROM of knee flexion \nbilaterally, her exam was not consistent with septic arthritis. \nShe was seen by ortho who felt this was not a septic joint, \nrather inflammation from trauma. She was C.diff positive and \nstarted on PO vancomycin after which her leukocytosis and fevers \nresolved. She will continue PO vanc till 1.30.\n\n#Acute on chronic kidney disease: Patient became oliguric and \nhad Cr rise which peaked at 3.4. Urine sediment showed brown \nmuddy casts with urine eos, likely ATN vs AIN. Her Cr improved \nto baseline (1.4 at time of discharge) and she did not require \nHD and her urine output improved. She did become volume \noverloaded while she was oliguric and continues to have 1+ \npitting edema to her knees bilaterally. She was continued on \nher ___ Lasix 40 mg BID to which she has good response. She \nalso had bilateral upper extremity vein mapping in anticipation \nof future need for dialysis. She will have follow-up with her \noutpatient nephrologist. \n\n#Lower extremity pain: Edema likely ___ volume overload. Patient \ndeveloped some asymmetric pitting edema, R>L, but LENIs were \nnegative for DVT. She has pain to palpation in her BLE thought \nto be ___ volume overload, diabetic neuropathy. Her pain is not \nlocalized strictly in the joints. However, should she develop \nlocalized pain in her knees and passive ROM is completely \nlimited by pain, would consider checking a uric acid to assess \nfor gout. \n\n#DMI complicated by critical hypoglycemia, 40s. Patient \nevaluated by ___ who recommended Lantus 18u QAM + HISS. \nFSBGs well controlled while in-house in the 130s-240 range day \nprior to discharge.\n\n___ ulcers: The patient has multiple foot and lower extremity \nulcers with fibrinous exudates. None appeared to be actively \ninfected. Patient received ongoing wound care. The patient was \nevaluated by Vascular Surgery and Podiatry who did not think \nsurgical debridement was necessary. Patient has follow-up with \nPodiatry and Vascular Surgery.\n\n#Paroxysmal atrial fibrillation: Developed post op after CABG/ \ntissue valve surgery. Rate well controlled on ___ metoprolol. \nPatient was continued on her warfarin 2mg from rehab. However, \nshe became supratherapeutic so her coumadin was held. Her \ncoumadin was restarted, but then uptitrated to 3 mg qday after \nthe patient's subtherapeutic INR persisted. INR at discharge \nwas 2.1.\n\n*****TRANSITIONAL ISSUES*****\n- Code: full (confirmed)\n- Patient should have INR checked on ___. \n- If patient develops localized pain only in knee joint and \npassive ROM is completely limited by pain, can consider checking \na uric acid level. For now I would treat symptoms w/ tylenol", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain', 'Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 80 mg PO DAILY', 'Bethanechol 50 mg PO TID', 'Ciprofloxacin 0.3% Ophth Soln 3 DROP RIGHT EAR DAILY', 'Cyanocobalamin 500 mcg PO DAILY', 'Docusate Sodium 200 mg PO DAILY', 'Furosemide 40 mg PO BID', 'Gabapentin 300 mg PO DAILY', 'Levothyroxine Sodium 25 mcg PO DAILY', 'Metoprolol Succinate XL 12.5 mg PO HS', 'Nephrocaps 1 CAP PO DAILY', 'Pantoprazole 40 mg PO Q24H', 'TraMADOL (Ultram) 50 mg PO TID \nPlease do not take if very sleepy, with alcohol, or while \ndriving.', 'Florastor (saccharomyces boulardii) 250 mg oral BID', 'Vitamin D 50,000 UNIT PO 1X Q15DAY', 'Glargine 18 Units Breakfast\nGlargine 0 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'Warfarin 3 mg PO DAILY16', 'Vancomycin Oral Liquid ___ mg PO Q6H Duration: 8 Days \ntake till ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 65, 'gender': 'M', 'symptoms': '"I was scaring my mom"', 'medical_history': ['- Polycystic ovarian syndrome, on birth control pills', '- Head concussion from being physically abused by brother 3 \nweeks\nago', '- Hit head really hard from passing out on Prazosin 3 weeks ago'], 'family_history': '- Maternal grandmother and great ___, depression\n- Many paternal relatives have mental illness\n- ___ cousin attempted suicide recently\n.', 'present_illness': 'FROM ADMISSION NOTE ON ___\n.\n___ yo F with reported history of depression, anxiety, bipolar I \ndisorder, ADHD, OCD, PTSD and 2 recent psychiatric \nhospitalization over the past couple months who present with \nworsening SI and increasing anxiety in the context of recent \ndischarge from ___ and medication changes. \n.\nPer Dr. ___ ___ note:\n"Pt reports she has been struggling for depression, anxiety, and \nADHD since ___ grade. She reports her depression and anxiety \nhave been getting worse over the past ___ years. She reports she \nstarted to have SI 6 months ago. She attempted suicide by \ndriving a car really fast into a tree. She was subsequently \nhospitalized at ___ psych unit for 2 weeks. She \nwas discharged, and then re-admitted the next day due to \nrecurring anxiety and depression. She says she had a bad car \naccident 2 months ago.\n.\nWhen she was in the car shortly after her ___ discharge, she had\nintense flashbacks and anxiety which led to her ___ \nre-hospitalization. She had active SI at that time too. During \nher 2 hospitalizations, she was tappered off Celexa, and started \non Gabapentin, Guanfacine, Lithium, and Risperdal. She feels\nphysically discomfort with these new med change. She feels hand \nshakiness, dizziness, HA, nausea, and chills. She had SI over \nthe past 3 days due to the anxiety and stress. She reports SI \nwith plan to driving a car really fast until go off the road, or \nshoot herself with a gun. She says her father is a police \n___ who has ___ guns. She says his guns are locked up in \na safe, but she thinks she can figure out how to access them. \nShe lives with her parents"\n.\nUpon admission to the unit, patient reports that her mother \nbrought her to the ED because she had confided in her that she \nwas having suicidal thoughts and did not want to live anymore. \nDescribes that three weeks ago she was driving and had thoughts \nof wanting to drive into a tree to end her life and was speeding \nat 90 mph, she was able to stop herself and pull over and calm\ndown but describes this episode like a "blackout". Then drove \nherself to the hospital and was admitted at ___, \n___ for two weeks where she was diagnosed with bipolar I \ndisorder, tapered off of Celexa and started on lithium and \nRisperdal. After discharge, she states she was sitting in her \ncar to drive home but was too anxious so returned to the \nhospital and was\nreadmitted for one week during which time she was trialed on \nPrazosin (with no effect on her nightmares), and started on \nGabapentin and Trazodone. Since discharge ~4 days ago, she \nreports things have been worse, which she believes is due to her \nmedications. She states she has been feeling more sad, helpless\nand hopeless and increasing anxiety. She attributes this to \nhaving more stimulation since discharge and thinks that while in \nthe hospital she had gotten into a routine which is important to \nher. She states that being at home is stressful and describes a \ntumultuous relationship with both her father who is a ___ \n___ and her brother (who lives in ___ and states \nthat both of them have been physically abusive towards her (most \nrecently 3 weeks ago when she sustained a concussion due to her \nbrother hitting her). Her mother brought her to ___ to visit \nfamily yesterday in the hopes that the change in setting would \nbe helpful, but she found her anxiety increased and her mom was\nconcerned for her safety and brought her to the emergency room. \n.\nReport she feels safe on the unit, endorses SI but no intent \ncurrently. Denies HI/AVH. \n.\nPsychiatric ROS:\nPer Dr. ___ ___ note, with updates on admission:\nDepression - reports symptoms including anhedonia, hopelessness, \nguilt, fatigue, difficulty concentrating, changes in appetite, \nand sleep disturbances.\nAnxiety - reports nightmares and flashbacks from recent car \naccident and physical abuse by her father and brother in \nchildhood. Reports anxiety triggered by noises or external \nstimulation, and unknowns. She reports obsession with things in \nparticular orders. No excessive hand washing. \nMania- reports symptoms in the past, but not currently including \nelevated mood or irritability, marked increases in goal-directed \nbehavior (excessive shopping on expensive unnecessary stuff), \nracing thoughts, a decreased need for sleep, or social/economic \nindiscretion.\nPsychosis - denies AVH, reports paranoia such as thinking \nsomeone listening to her phone calls or her dad putting a \ntracking device in her phone/car. \n.\nED Course:\nPatient was in good behavioral control. She did not require any \nchemical or mechanical restraints. \n.\nROS: + chills, tremors, nausea, headache, constipation (last BM \n5 days ago).\nDenies fevers, vomiting, diarrhea, abdominal pain, chest pain, \npalpitations, shortness of breath, lightheadedness, \nparesthesias, blurry vision.\n.\n.', 'medications': [{'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '44.9', 'valuenum': 44.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.17', 'valuenum': 5.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 67 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.3', 'valuenum': 43.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.4, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.032', 'valuenum': 1.032, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.1', 'valuenum': 48.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '380', 'valuenum': 380.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '268', 'valuenum': 268.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '408', 'valuenum': 408.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-5', 'valuenum': -5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.16', 'valuenum': 1.16, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '502', 'valuenum': 502.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 185.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.23', 'valuenum': 3.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'PHYSICAL EXAM AT ADMISSION ON ___\n.\nVS: T 98.0, BP 134/89, HR 94, RR 17, O2 100% RA\n.\nGeneral: NAD. Well-nourished, well-developed. Appears stated \nage.\nHEENT: Normocephalic, atraumatic. PERRL, EOMI. Oropharynx clear.\nNeck: Supple.\nLungs: CTA ___. No crackles, wheezes, or rhonchi.\nCV: RRR, no murmurs/rubs/gallops. \nAbdomen: +BS, soft, nontender, nondistended. No palpable masses\nor organomegaly.\nExtremities: No clubbing, cyanosis, or edema.\nSkin: No rashes noted.\n.\n.\nNEUROLOGIC EXAMINATION:\n- Cranial Nerves: PERRL, EOMI, face symmetric, facial sensation\nintact, hearing grossly intact, no dysarthria, tongue/uvula\nmidline, shoulder shrug intact \n- Motor: Normal bulk and tone bilaterally. Full strength ___ \nthroughout. + Mild, fine resting and intention tremor noted\nbilaterally, R>L\n- Coordination: No finger to nose dysmetria noted\n- Sensation: Intact to light touch throughout.\n- Gait: Steady. Normal stance and posture. No truncal ataxia.\n.\n.\nCOGNITIVE EXAM: \n- Wakefulness/alertness: awake and alert\n- Attention: WORLD backwards intact\n- Orientation: oriented to person, situation. States we are in\nBWH and date is ___ rather than ___. \n- Memory: intact to recent and past history. ___\nregistration/immediate recall\n- Fund of knowledge: knows last two presidents and first\npresident of US\n- Calculations: correctly states 9 quarters in $2.25\n- Abstraction: train + bicycle = "wheels"\n- Proverb: "don\'t judge a book by it\'s cover" = "understand the\ndeeper meaning not just what it looks like"\n- Speech: normal rate, volume, and tone\n- Language: native ___ speaker, no paraphasic errors,\nappropriate to conversation\n.\n.\nMENTAL STATUS EXAM:\n- Appearance: Overweight female, appears stated age,\nwell-groomed, wearing colorful headband, hospital gown and\nwrapped in a blanket\n- Behavior: pleasant, cooperative, fidgeting, appears anxious\n- Mood: "depressed"\n- Affect: anxious appearing, reactive\n- Thought Process: linear, logical\n- Thought Content: no overtly delusional content, endorses SI\nwith plan. No HI/AVH\n- Judgment/Insight: limited/limited\n.\n.', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '5122', 'desc': 'Postoperative air leak'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '79029', 'desc': 'Other abnormal glucose'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'V173'}, {'icd_code': '72632', 'desc': 'Lateral epicondylitis'}, {'icd_code': '45829', 'desc': 'Other iatrogenic hypotension'}, {'icd_code': 'E8782', 'desc': 'Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '4549', 'desc': 'Asymptomatic varicose veins'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '99889', 'desc': 'Other specified complications of procedures not elsewhere classified'}, {'icd_code': 'E8768', 'desc': 'Other specified misadventures during medical care'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}], 'summary': '___ 07:09PM BLOOD WBC-7.1 RBC-3.73* Hgb-11.6 Hct-33.9* \nMCV-91 MCH-31.1 MCHC-34.2 RDW-13.2 RDWSD-44.3 Plt ___\n___ 07:09PM BLOOD Neuts-55.7 ___ Monos-9.2 Eos-3.2 \nBaso-0.7 Im ___ AbsNeut-3.94 AbsLymp-2.20 AbsMono-0.65 \nAbsEos-0.23 AbsBaso-0.05\n___ 07:09PM BLOOD Glucose-89 UreaN-11 Creat-0.9 Na-139 \nK-3.8 Cl-106 HCO3-25 AnGap-12\n___ 05:20AM BLOOD Cholest-165\n___ 05:20AM BLOOD Triglyc-146 HDL-52 CHOL/HD-3.2 LDLcalc-84\n___ 03:33AM BLOOD TSH-7.5*\n___ 05:20AM BLOOD TSH-4.5*\n___ 07:09PM BLOOD TSH-8.8*\n___ 03:33AM BLOOD T4-8.2\n___ 05:20AM BLOOD T4-7.7\n___ 03:33AM BLOOD Lithium-0.9\n___ 07:09PM BLOOD Lithium-0.6\n___ 07:09PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\nMs. ___ is a ___ yo F with reported history of depression, \nanxiety, bipolar I\ndisorder, ADHD, OCD, PTSD and 2 recent psychiatric \nhospitalization over the past couple months who present with \nworsening SI and increasing anxiety in the context of recent \ndischarge from ___ and medication changes. \n.\nDuring this hospital course, the patient reported acute on \nchronic worsening depression, anxiety, and PTSD symptoms in the \nsetting of recent physical abuse by brother and new med changes. \nShe also reported SI with plan and recent suicide attempt which \nrequired inpatient psychiatric hospitalizations. Exam was \nnotable\nfor anxious appearance and affect, linear thought process and \nSI. Neurological exam was non-focal but notable for subtle \nbilateral tremors of unclear etiology.\n.\nOn subsequent interviews, she was found to be pleasant on \napproach but becoming tearful and with louder volume when \ndescribing her frustrations and that "the mother daughter \nrelationship is so hard." \n.\nOn ___, a family meeting was held with the mother. During \nthat day the patient was also coached on her own communication \nstyles with others. Overall the patient was very appreciative of \nthese events and stated that this inpatient stay has been \nhelpful for her. She described her mood as "more calm" and \nexpressed hopefulness and excitement about her future and her \nlife ahead as an independent young woman.\n.\nDiagnostically, the differential includes bipolar disorder and \nshe is currently on lithium as a mood stabilizer which has been \nhelpful per pt, in addition to prn vistaril. In addition, her hx \nalso contains elements of generalized anxiety disorder, PTSD, \nand cannabis use disorder.\n.\n.\n1) Legal/Safety: \n- Patient was admitted to Deaconess 4 on a ___, upon \nadmission he signed a CV which was accepted. \n- She maintained good behavioral control throughout her \npsychiatric hospitalization on 15 minute checks and did not \nrequire physical or chemical restraints. \n- Given her emotional volatility at admission, she was \nconsidered to not be a candidate for Fresh Air during this \nadmission.\n.\n.\n2) Psychiatric\n# Bipolar Disorder\n- Patient was compliant in attending groups, maintained good \nbehavioral control in the milieu, and was compliant in meeting \nwith his treatment team, participating appropriately in her \ncare.\n- After discussion of the risks and benefits, the patient was \nstarted on Invega, with dose increase during this admission to \nInvega 6 mg PO daily. Of note, he \ntolerated this well with no complaints of side effects. Her \nregimen also included Vistaril as needed. Her home medication \nLithium 600 mg p.o. twice daily was continued.\n- During this admission, seroquel was discontinued per pt\'s \nrequest. She noted a historical trial of risperdal but that this \nled to shakiness and her right leg bouncing. In our emergency \ndepartment, the following prior medications were also held: \nRisperdal 0.5mg q4h PRN, PRN Tylenol ___ q4h, Adderall 15mg \nqAM, Gabapentin 300mg QID, Guanfacine 1mg BID, Trazodone 50mg \nqhs PRN\n- On this regimen and in the setting of the stabilizing \nenvironment of the milieu, the patient reported improvement in \nmood, consistently denying suicidal ideation or thoughts of self \nharm during this hospitalization. By time of discharge, she was \nnoted to have thought process that was notably linear, goal and \nfuture oriented and stated she was looking forward to her life \nas an independent young woman.\n- Prior to discharge, a family meeting was held with the \npatient\'s mother to discuss presentation, hospital course, and \ntreatment. The mother agreed with above treatment, the plan for \ndischarge, and was supportive of her care.\n- On the day of discharge, the patient stated that she felt \n"more calm" and that the inpatient medication regimen has been \nhelpful. She denied any side effects.\n.\n# Cannabis use disorder\n- Patient received psychoeducation and counseling on the \ndeleterious effects of cannabis on her mental health\n.\n3) General Medical Conditions\n.\n#Constipation\n- The patient received lactulose, with discontinuation during \nthis hospital course of Colace and miralax. Continue to \nencourage healthy well-balanced diet and to stay hydrated with \nplenty of water intake.\n.\n#Elevated TSH\nContinue to follow\nDuring this admission TSH 7.5 (elevated) but T4 8.2 (wnl)\n.\n#Hx of Head trauma 3 weeks prior to this admission\nPt currently feels well, vital signs stable\nConsider CT Head if changes in presentation or mental status\n.\n#PCOS\n- Continue Balziva (OCP)'}}
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{'final_diagnoses': ['Bipolar disorder, current depressive episode', 'R/o bipolar disorder with psychotic features', 'Generalized anxiety disorder', 'PTSD', 'Cannabis use disorder'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ yo F with reported history of depression, \nanxiety, bipolar I\ndisorder, ADHD, OCD, PTSD and 2 recent psychiatric \nhospitalization over the past couple months who present with \nworsening SI and increasing anxiety in the context of recent \ndischarge from ___ and medication changes. \n.\nDuring this hospital course, the patient reported acute on \nchronic worsening depression, anxiety, and PTSD symptoms in the \nsetting of recent physical abuse by brother and new med changes. \nShe also reported SI with plan and recent suicide attempt which \nrequired inpatient psychiatric hospitalizations. Exam was \nnotable\nfor anxious appearance and affect, linear thought process and \nSI. Neurological exam was non-focal but notable for subtle \nbilateral tremors of unclear etiology.\n.\nOn subsequent interviews, she was found to be pleasant on \napproach but becoming tearful and with louder volume when \ndescribing her frustrations and that "the mother daughter \nrelationship is so hard." \n.\nOn ___, a family meeting was held with the mother. During \nthat day the patient was also coached on her own communication \nstyles with others. Overall the patient was very appreciative of \nthese events and stated that this inpatient stay has been \nhelpful for her. She described her mood as "more calm" and \nexpressed hopefulness and excitement about her future and her \nlife ahead as an independent young woman.\n.\nDiagnostically, the differential includes bipolar disorder and \nshe is currently on lithium as a mood stabilizer which has been \nhelpful per pt, in addition to prn vistaril. In addition, her hx \nalso contains elements of generalized anxiety disorder, PTSD, \nand cannabis use disorder.\n.\n.\n1) Legal/Safety: \n- Patient was admitted to Deaconess 4 on a ___, upon \nadmission he signed a CV which was accepted. \n- She maintained good behavioral control throughout her \npsychiatric hospitalization on 15 minute checks and did not \nrequire physical or chemical restraints. \n- Given her emotional volatility at admission, she was \nconsidered to not be a candidate for Fresh Air during this \nadmission.\n.\n.\n2) Psychiatric\n# Bipolar Disorder\n- Patient was compliant in attending groups, maintained good \nbehavioral control in the milieu, and was compliant in meeting \nwith his treatment team, participating appropriately in her \ncare.\n- After discussion of the risks and benefits, the patient was \nstarted on Invega, with dose increase during this admission to \nInvega 6 mg PO daily. Of note, he \ntolerated this well with no complaints of side effects. Her \nregimen also included Vistaril as needed. Her home medication \nLithium 600 mg p.o. twice daily was continued.\n- During this admission, seroquel was discontinued per pt\'s \nrequest. She noted a historical trial of risperdal but that this \nled to shakiness and her right leg bouncing. In our emergency \ndepartment, the following prior medications were also held: \nRisperdal 0.5mg q4h PRN, PRN Tylenol ___ q4h, Adderall 15mg \nqAM, Gabapentin 300mg QID, Guanfacine 1mg BID, Trazodone 50mg \nqhs PRN\n- On this regimen and in the setting of the stabilizing \nenvironment of the milieu, the patient reported improvement in \nmood, consistently denying suicidal ideation or thoughts of self \nharm during this hospitalization. By time of discharge, she was \nnoted to have thought process that was notably linear, goal and \nfuture oriented and stated she was looking forward to her life \nas an independent young woman.\n- Prior to discharge, a family meeting was held with the \npatient\'s mother to discuss presentation, hospital course, and \ntreatment. The mother agreed with above treatment, the plan for \ndischarge, and was supportive of her care.\n- On the day of discharge, the patient stated that she felt \n"more calm" and that the inpatient medication regimen has been \nhelpful. She denied any side effects.\n.\n# Cannabis use disorder\n- Patient received psychoeducation and counseling on the \ndeleterious effects of cannabis on her mental health\n.\n3) General Medical Conditions\n.\n#Constipation\n- The patient received lactulose, with discontinuation during \nthis hospital course of Colace and miralax. Continue to \nencourage healthy well-balanced diet and to stay hydrated with \nplenty of water intake.\n.\n#Elevated TSH\nContinue to follow\nDuring this admission TSH 7.5 (elevated) but T4 8.2 (wnl)\n.\n#Hx of Head trauma 3 weeks prior to this admission\nPt currently feels well, vital signs stable\nConsider CT Head if changes in presentation or mental status\n.\n#PCOS\n- Continue Balziva (OCP)', 'medications_prescribed': ['HydrOXYzine 25 mg PO Q4H:PRN nausea, anxiety \nRX *hydroxyzine HCl 25 mg 1 tablet by mouth twice a day as \nneeded Disp #*60 Tablet Refills:*0', 'PALIperidone ER 6 mg PO DAILY \nRX *paliperidone 6 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'Balziva (28) (norethindrone-ethin estradiol) 0.4-35 mg-mcg \noral DAILY', 'Lithium Carbonate 600 mg PO BID \nRX *lithium carbonate 600 mg 1 capsule(s) by mouth twice a day \nDisp #*30 Capsule Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 54, 'gender': 'F', 'symptoms': 'abdominal pain, fever, loose stools', 'medical_history': ['IBS', 'Fibromyalgia', "Takotsubo's, ___ yrs ago", 'HTN', 'GERD', 'Depression', 'GERD', 'HL', 's/p umbilical hernia repair', 's/p T&A', 's/p hysterectomy'], 'family_history': "Mom - 'tangled bowel', melanoma\nHTN on mother/father's side\nbad colon problems on mother's side", 'present_illness': "___ with h/o IBS, fibromyalgia, HTN, GERD, depression who \npresents to the ED with fever, diffuse abd pain, and loose \nstools. She was in her USOH until yesterday when she began \ndeveloping lower abd pain. Today at work, the pain worsened and \nbecame more diffuse - intermittently sharp, espesially in the \nRLQ and LLQ. She had felt constipated the past few days but \ntoday had ___ loose, yellow bowel movements - not watery, \nsemi-formed. Today at work she also had fever to 101.2. She \nendorses nausea w/ dry heaves, abd distension, headache, chills, \nand diffuse jt pain. Of note, she recently completed augmentin \nfor a sinus infection - Rx was written on ___ for augmentin BID \nx 10 days but pt intermittently only took 1 dose/day and \nfinished the course 2 days ago. She did not have abd pain or \nloose stools while on antiBs. Also states that she is LPN and \nrecently saw a patient whom was later thought to have noro \nvirus. She is concerned she may have this.\n.\nIn the ED, initial VS: 101.2 104 132/72 18 100% on RA. Labs \nshowed WBC of 11.7 w/ 89N, K was 3, lactate 2.3. U/A was \nnegative. CXR nl. CT Abd showed 'Mild wall thickening throughout \nthe descending and sigmoid colon extending to the rectum, \ncompatible with mild distal colitis' and 'Moderate fecal loading \nthroughout the ascending and transverse colon only'. She was \ngiven tylenol, morphine, zofran, 500 mg IV flagyl, and 2L NS as \nwell as 40 mEq K+.\n.\nCurrently, the patient is tearful and intermittently moans in \npain. She states her abdominal pain is diffuse and that all of \nher joints are hurting. She asks for more nausea medication. No \nh/o C.diff infection.\n.", 'medications': [{'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Cepastat (Phenol) Lozenge', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.4', 'valuenum': 84.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Physical Exam on Admission:\nVS - 100.7 98 122/68 16 98% on RA\nGENERAL - tearful, moans in pain, able to give a good medical \nhistory\nHEENT - PERRLA, EOMI, dry MM, OP clear\nNECK - Supple, no JVD\nHEART - RRR, soft systolic murmur\nLUNGS - CTAB, unlabored\nABDOMEN - hypoactive bs, soft, diffusely tender - worst in LLQ \nand epigastrium\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, full strength \nin bil ___\n.\nPhysical Exam on Discharge:\nVS - afebrile, vital signs stable \nGENERAL - awake in bed, watching movie on lap top\nHEENT - PERRLA, EOMI, dry MM, OP clear\nNECK - Supple, no JVD\nHEART - RRR, soft systolic murmur\nLUNGS - CTAB, unlabored\nABDOMEN - hypoactive bs, soft, diffusely tender - worst in LLQ \nand epigastrium\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, full strength \nin bil ___', 'diagnoses': [{'icd_code': '5771', 'desc': 'Chronic pancreatitis'}, {'icd_code': '57450', 'desc': 'Calculus of bile duct without mention of cholecystitis, without mention of obstruction'}, {'icd_code': '7906', 'desc': 'Other abnormal blood chemistry'}, {'icd_code': '99739', 'desc': 'Other respiratory complications'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}, {'icd_code': 'E8798', 'desc': 'Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': 'V641'}, {'icd_code': '28850', 'desc': 'Leukocytopenia, unspecified'}, {'icd_code': 'V4586', 'desc': 'Bariatric surgery status'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '78321', 'desc': 'Loss of weight'}, {'icd_code': 'V851'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': 'Labs on Admission:\n\n___ 08:20PM WBC-11.7* RBC-3.96* HGB-12.7 HCT-36.0 MCV-91 \nMCH-32.1* MCHC-35.3* RDW-12.0\n___ 08:20PM NEUTS-89.2* LYMPHS-7.1* MONOS-2.7 EOS-0.5 \nBASOS-0.5\n___ 08:20PM GLUCOSE-130* UREA N-11 CREAT-0.7 SODIUM-137 \nPOTASSIUM-3.0* CHLORIDE-99 TOTAL CO2-29 ANION GAP-12\n___ 08:25PM LACTATE-2.3*\n___ 06:20AM CALCIUM-8.8 PHOSPHATE-1.1* MAGNESIUM-1.8\n___ 06:20AM ALT(SGPT)-28 AST(SGOT)-20 ALK PHOS-57 TOT \nBILI-0.7\n___ 08:00PM URINE HOURS-RANDOM\n___ 08:00PM URINE UCG-NEG\n___ 08:00PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 08:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n.\nChest x-ray:\nThe heart size is normal. The hilar and mediastinal contours are \nwithin normal limits. There is no pneumothorax, focal \nconsolidation, or pleural effusion.\n. \nIMPRESSION: No acute intrathoracic process.\n.\nCT abdomen/pelvis with contrast:\n1. Mild wall thickening from the splenic flexture extending to \nthe rectum\ncompatible with colitis. Appearance favors inflammatory or \ninfectious. No\nextramural disease.\n2. Moderate fecal loading only within the ascending and \ntransverse colon.\n.\nMicrobiology:\n___ 3:05 pm STOOL CONSISTENCY: NOT APPLICABLE\n Source: Stool. \n\n **FINAL REPORT ___\n\n CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final ___: \n Reported to and read back by ___ @ 7:21A \n___. \n CLOSTRIDIUM DIFFICILE. \n FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA. \n (Reference Range-Negative). \n A positive result in a recently treated patient is of \nuncertain\n significance unless the patient is currently \nsymptomatic\n (relapse). \n.\nUrine culture: neg\nBlood culture x2: neg\n.\nLabs on Discharge:\n\n___ 06:45AM BLOOD WBC-7.7 RBC-3.44* Hgb-11.0* Hct-31.2* \nMCV-91 MCH-32.1* MCHC-35.3* RDW-12.6 Plt ___\n___ 06:45AM BLOOD Glucose-94 UreaN-7 Creat-0.8 Na-143 \nK-3.2* Cl-110* HCO3-28 AnGap-___ with h/o IBS, fibromyalgia, HTN, GERD, depression \npresented to the ED with fever, diffuse abdominal pain, and \nloose stools.\n# C. diff colitis: Risks included recent prolonged Augmentin \ncourse, and chronic PPI use. CT scan indicative of mild distal \ncolitis. C. dif toxin was positive. Patient was treated with IV \nflagyl and then transitioned to PO. Symptoms improved. On \ndischarge, patient will complete 2 week course of flagyl. PPI \nwas discontinued, and she will monitor GERD symptoms on H2 \nblocker therapy with PCP ___. \n.\n# HTN: Held HCTZ and ___ during admission initially given \ndehydration, but re-started ___ on discharge. Will ___ with PCP \nand then make the decision of when to re-start ___. \n.\n# Depression/Anxiety: Continued home lexapro, xanax.\n.\n# Fibromyalgia: Continued home neurontin, flexeril, \namitriptyline.\n.\n# GERD: Discontinued home protonix, started Ranitidine instead.'}}
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{'final_diagnoses': ['C. dificile'], 'procedures': ['none'], 'visit_summary': '# C. diff colitis: Risks included recent prolonged Augmentin \ncourse, and chronic PPI use. CT scan indicative of mild distal \ncolitis. C. dif toxin was positive. Patient was treated with IV \nflagyl and then transitioned to PO. Symptoms improved. On \ndischarge, patient will complete 2 week course of flagyl. PPI \nwas discontinued, and she will monitor GERD symptoms on H2 \nblocker therapy with PCP ___. \n.\n# HTN: Held HCTZ and ___ during admission initially given \ndehydration, but re-started ___ on discharge. Will ___ with PCP \nand then make the decision of when to re-start ___. \n.\n# Depression/Anxiety: Continued home lexapro, xanax.\n.\n# Fibromyalgia: Continued home neurontin, flexeril, \namitriptyline.\n.\n# GERD: Discontinued home protonix, started Ranitidine instead.', 'medications_prescribed': ['1. escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. gabapentin 100 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily).', '3. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO HS (at \nbedtime).', '4. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime) as needed for muscle spasm.', '5. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime.', '6. Vicodin ___ mg Tablet Sig: ___ Tablets PO every ___ hours \nas needed for pain.', '7. amitriptyline 25 mg Tablet Sig: 0.5 Tablet PO HS (at \nbedtime).', '8. irbesartan 75 mg Tablet Sig: 0.5 Tablet PO once a day.', '9. multivitamin Tablet Sig: One (1) Tablet PO once a day.', '10. Calcium 500 Oral', '11. Vitamin D3 Oral', '12. Flonase Nasal', '13. metoprolol succinate Oral', '14. Restasis 0.05 % Dropperette Sig: One (1) Ophthalmic once a \nday.', '15. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: \n___ Puffs Inhalation Q6H (every 6 hours) as needed for SOB.', '16. Miralax 17 gram/dose Powder Sig: One (1) PO twice a day as \nneeded for constipation.', '17. Acidophilus Oral', '18. Vitamin B-12 500 mcg Tablet Sig: One (1) Tablet PO once a \nday.', '19. Fish Oil Oral', '20. red yeast rice Oral', '21. metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 \ntimes a day).\nDisp:*68 Tablet(s)* Refills:*0*', '22. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).\nDisp:*60 Tablet(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 19, 'gender': 'M', 'symptoms': 'gi bleed', 'medical_history': ['1. Hypertension.', '2. Pacemaker for sick sinus syndrome - interrogated on ___, \nfunctioning normally with no atrial or ventricular arrhythmias.', '3. CAD, status triple-vessel CABG in ___, EF= 40%. Most recent \nECHO in ___, showing LV inferior hypokinesis, mild MR, \nborderline pulm htn.', '4. Peripheral vascular disease, status post left femorotibial \nbypass and status post two toe amputations.', '5. Hypothyroid.', '6. Diabetes, insulin-dependent.', '7. Chronic renal failure: Baseline creatinine 1.8-2.1.', '8. Kidney stones.', '9. Spinal stenosis.', '10. Soft tissue density in the pancreas uncinate. Evaulated by \nGastroenterology in ___.', '11. Three pleural based nodules, seen on prior CT scan.', '12. History of several pneumonias.', '13. CVA in ___ with residual left facial droop and right leg \nweakness.', '14. Osteoarthritis.', '15. Chornic Anemia', '16. GIB (___) - s/p colonoscopies and EGD. Found to have \npolyps, internal hemorrhoids, and gastritis.'], 'family_history': 'Mother: hypertension. \nFather: died at age ___ in ___. \nSister: hypertension and a heart problem. \nNo colon cancer or gastric cancer in his family history. \nDaughter and grandson also have chronic anemia.', 'present_illness': "Semen ___ is a ___ yo ___ Speaking male with multiple \nmedical problems including sick sinus syndrome s/p pacemaker, \nCAD, CHF (EF 40-45%), DM, PVD, history of lower GI bleed \npresenting to ED with chest pressure and found to have a GI \nbleed. Of note the patient underwent an EGD and a colonoscopy on \n___ for work up of iron deficiency anemia. Colonoscopy showed 5 \npolyps which were removed and noted internal hemorrhoids. EGD \nwas notable for mild gastritis and biopsy was neg for H pylori. \nHe was feeling well until yesterday. Yesterday, he began feeling \nlightheaded, dizzy, and had an episode of chest tightness. He \nalso notes 2 episodes of diarrhea last night. He did not note \nthe stool color. He checks his BP daily and it was ___ \nyesterday and was low again this morning; pre-morning meds his \nbp is often 180/80 and is 110/80 with meds. He had some chest \ntightness last night and had it again this morning so came to \nthe ED. The CP is not like his previous MI. He denies associated \nSOB, diaphoresis. No nausea, vomiting or abdominal pain. The \npatient's daughter states that he was taking some ibuprofen \nrecently for shoulder pain. \n. \nIn the ED, initial vs were: 97.8 84 125/57 16 100%. Patient was \ngiven Aspirin 325mg POx1, morphine 4 mg IV x1 and SL nitro x1, \nbut continues to have mild chest pain. On exam, rectal exam \nrevealed red stool and was guiaic positive. The patient refused \nNG lavage. GI was consulted and they plan to see him in the ICU. \nHe is cross-matched for 4 units but has not yet received any. He \nhas remained hemodynamically stable. His VS prior to transfer \nare 69 130/48 16 100% 4L. \n. \nIn the ICU, he was reporting moderate to severe chest tightness \nwhich resolved with 2 NTG tablets. In addition, he was \ncomplaining of left shoulder pain which was reproducible to \npalpation. \n. \nReview of sytems: \n(+) Per HPI and for ___ pillow orthopnea and PND, left shoulder \nand back pain, headache and thirst \n(-) Denies fever, chills, night sweats, recent weight loss or \ngain. Denies sinus tenderness, rhinorrhea or congestion. Denied \ncough, shortness of breath. Denied palpitations. Denied nausea, \nvomiting, diarrhea, constipation or abdominal pain. No recent \nchange in bowel or bladder habits. No dysuria. Denied \narthralgias or myalgias.", 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'GlycoLax', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'ORAL', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 20-29 is 116 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCCASIONAL.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63.1', 'valuenum': 63.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 14.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '60 IU/ML CORRESPONDS TO 1:80 TITER, 120 IU/ML TO 1:160 TITER, ETC.'}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.73', 'valuenum': 0.73, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.74', 'valuenum': 0.74, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '59.0', 'valuenum': 59.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': 'Pos/Neg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '330', 'valuenum': 330.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '254', 'valuenum': 254.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}], 'exams': 'Vitals: AF 67 142/60 17 99% 2L \nSBP 130 -->120 with change from lying to sitting. \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP 10, no LAD \nLungs: no dullness to percussion, bilat crackles in lower ___, \nno wheezes/rhonchi \nCV: Distant heart sounds, Regular rate and rhythm, normal S1 + \nS2, no murmurs, rubs, gallops. CP not reproducible. \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nRectal: normal tone, dark red stool, Guiaic positive. \nExt: warm, well perfused, unable to palpate DP or ___ bilat, s/p \nright metatarsal amputation and left foot surgery, no clubbing, \ncyanosis. ___ ___ pitting edema to knees.', 'diagnoses': [{'icd_code': '78909', 'desc': 'Abdominal pain, other specified site'}, {'icd_code': '78959', 'desc': 'Other ascites'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '3071', 'desc': 'Anorexia nervosa'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '2841', 'desc': 'Pancytopenia'}], 'summary': "___ 07:20AM BLOOD WBC-8.4 RBC-2.30*# Hgb-6.7*# Hct-20.3*# \nMCV-88 MCH-29.0 MCHC-32.8 RDW-15.9* Plt ___\n___ 01:54PM BLOOD WBC-8.6 RBC-2.83* Hgb-8.1* Hct-24.9* \nMCV-88 MCH-28.7 MCHC-32.7 RDW-14.7 Plt ___\n___ 03:27AM BLOOD WBC-8.7 RBC-3.78*# Hgb-11.6*# Hct-33.3* \nMCV-88 MCH-30.5 MCHC-34.7 RDW-15.1 Plt Ct-56*#\n___ 03:51PM BLOOD WBC-12.9* RBC-3.99* Hgb-11.8* Hct-33.8* \nMCV-85 MCH-29.5 MCHC-34.9 RDW-15.0 Plt ___\n___ 01:57AM BLOOD WBC-10.8 RBC-3.62* Hgb-11.0* Hct-31.8* \nMCV-88 MCH-30.4 MCHC-34.5 RDW-15.4 Plt ___\n___ 07:01AM BLOOD WBC-10.8 RBC-3.61* Hgb-11.0* Hct-30.8* \nMCV-85 MCH-30.5 MCHC-35.7* RDW-15.2 Plt ___\n___ 07:20AM BLOOD Glucose-161* UreaN-76* Creat-2.5* Na-140 \nK-4.4 Cl-108 HCO3-19* AnGap-17\n___ 01:54PM BLOOD Glucose-124* UreaN-68* Creat-2.0* Na-143 \nK-4.1 Cl-112* HCO3-20* AnGap-15\n___ 03:27AM BLOOD Glucose-135* UreaN-64* Creat-2.0* Na-139 \nK-4.6 Cl-110* HCO3-19* AnGap-15\n___ 01:57AM BLOOD Glucose-165* UreaN-45* Creat-1.6* Na-138 \nK-6.4* Cl-109* HCO3-19* AnGap-16\n___ 07:01AM BLOOD Glucose-99 UreaN-49* Creat-1.9* Na-143 \nK-3.5 Cl-108 HCO3-23 AnGap-16\n___ 07:20AM BLOOD cTropnT-0.05*\n___ 01:54PM BLOOD CK-MB-8 cTropnT-0.18*\n___ 06:59PM BLOOD CK-MB-11* MB Indx-7.1* cTropnT-0.30*\n___ 03:27AM BLOOD CK-MB-10 MB Indx-6.5* cTropnT-0.36*\n___ 10:12AM BLOOD CK-MB-11* MB Indx-8.2* cTropnT-0.54*\n___ 03:51PM BLOOD CK-MB-8 cTropnT-0.46*\n___ 01:57AM BLOOD CK-MB-4 cTropnT-0.25*\n___ yo ___ Speaking male with multiple medical problems \nincluding sick sinus syndrome s/p pacemaker, CAD, CHF (EF \n40-45%), DM, PVD, history of lower GI bleed presenting to ED \nwith chest pressure and found to have a GI bleed. \n \n# Acute blood loss anemia: Secondary to bleeding from GI tract \nmost likely from the site of the polypectomy in the setting of \nNSAIDS use and plavix. The patient received 4 U RBC's in the ICU \nand remained hemodynamically stable. A prep was done with \nintention to do a c-scope, but the patient was thought to be too \nunstable. He HCT then leveled off as the plavix wore off and he \nwas transferred to the floor. No c-scope was performed as it was \nassumed that this was a low bleed from the polypectomy site and \nit had stopped. He will have his HCT checked 2 days after \ndischarge with ___.\n \n# Chest pain: Patient with substantial history of CAD. CP most \nlikely demand ischemia given acute blood loss and in the morning \neven with hematocrit at baseline his CAD meds had been held and \nhis pressure was 180s. CP releieved initially with nitro gtt \nthen added back isosorbide dinitrate and ___ started home imdur. \nMetoprolol restarted at home dose. Biomarkers trended down. \ncontinued statin. held plavix. he will continue to hold his \nplavix until he follow up with Dr. ___ in 1 week. \n \n# Sick sinus syndrome: A-V paced at HR in ___. amio continued.\n \n# Chronic systolic heart failure: Patient's most recent EF \n40-45%. After blood, pt with SOB, orthopnea, rales that required \nIV lasix dosing for 3 days. At the time of discharge he was on \nroom air and euvolemic. he was discharged on his home lasix \ndose. \n \n# DM, type II: home insulin continued. \n \n# Chronic renal insuffiency: Cr stayed approximately at \nbaseline.\n \n# Hypothyroid: Continue synthroid. \n \n# Glaucoma: Continue eye gtt. \n \n# Shoulder pain: long-standing problem. \n- morphine and tramadol prn. no NSAIDS."}}
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{'final_diagnoses': ['Primary Diagnosis: 285.1 ANEMIA, ACUTE BLOOD LOSS', 'Secondary Diagnosis: 414.05 CAD, BYPASS GRAFT', 'Secondary Diagnosis: 401.1 HYPERTENSION, BENIGN', 'Secondary Diagnosis: 250.80 DIABETES TYPE II, CONTROLLED W/ \nCOMPLICATIONS', 'Secondary Diagnosis: 244.9 HYPOTHYROIDISM', 'Secondary Diagnosis: 584.9 ACUTE RENAL FAILURE', 'Secondary Diagnosis: 578.9 BLEEDING, GASTROINTESTINAL NOS', 'Secondary Diagnosis: 287.5 THROMBOCYTOPENIA, UNSPECIFIED', 'Secondary Diagnosis: ___ MYOCARDIAL INFARCTION, NSTEMI', 'Secondary Diagnosis: ___ HEART FAILURE, (B1) ACUTE DIASTOLIC'], 'procedures': ['none'], 'visit_summary': "___ yo ___ Speaking male with multiple medical problems \nincluding sick sinus syndrome s/p pacemaker, CAD, CHF (EF \n40-45%), DM, PVD, history of lower GI bleed presenting to ED \nwith chest pressure and found to have a GI bleed. \n \n# Acute blood loss anemia: Secondary to bleeding from GI tract \nmost likely from the site of the polypectomy in the setting of \nNSAIDS use and plavix. The patient received 4 U RBC's in the ICU \nand remained hemodynamically stable. A prep was done with \nintention to do a c-scope, but the patient was thought to be too \nunstable. He HCT then leveled off as the plavix wore off and he \nwas transferred to the floor. No c-scope was performed as it was \nassumed that this was a low bleed from the polypectomy site and \nit had stopped. He will have his HCT checked 2 days after \ndischarge with ___.\n \n# Chest pain: Patient with substantial history of CAD. CP most \nlikely demand ischemia given acute blood loss and in the morning \neven with hematocrit at baseline his CAD meds had been held and \nhis pressure was 180s. CP releieved initially with nitro gtt \nthen added back isosorbide dinitrate and ___ started home imdur. \nMetoprolol restarted at home dose. Biomarkers trended down. \ncontinued statin. held plavix. he will continue to hold his \nplavix until he follow up with Dr. ___ in 1 week. \n \n# Sick sinus syndrome: A-V paced at HR in ___. amio continued.\n \n# Chronic systolic heart failure: Patient's most recent EF \n40-45%. After blood, pt with SOB, orthopnea, rales that required \nIV lasix dosing for 3 days. At the time of discharge he was on \nroom air and euvolemic. he was discharged on his home lasix \ndose. \n \n# DM, type II: home insulin continued. \n \n# Chronic renal insuffiency: Cr stayed approximately at \nbaseline.\n \n# Hypothyroid: Continue synthroid. \n \n# Glaucoma: Continue eye gtt. \n \n# Shoulder pain: long-standing problem. \n- morphine and tramadol prn. no NSAIDS.", 'medications_prescribed': ['1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic QID (4 \ntimes a day).', '3. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.', '4. Insulin Glargine 100 unit/mL Solution Sig: ___ (36) \nunits Subcutaneous once a day.', '5. Insulin Lispro 100 unit/mL Insulin Pen Sig: One (1) dose from \nsliding scale as directed with meals Subcutaneous with meals.', '6. Imdur 60 mg Tablet Sustained Release 24 hr Sig: One (1) \nTablet Sustained Release 24 hr PO once a day.', '7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice \na day.', '8. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.', '9. Diovan 160 mg Tablet Sig: One (1) Tablet PO once a day.', '10. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO once a day.', '11. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for shoulder pain.\nDisp:*30 Tablet(s)* Refills:*1*', '12. Tylenol Extra Strength 500 mg Tablet Sig: Two (2) Tablet PO \nthree times a day.', '13. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'R leg radicular pain', 'medical_history': ['HTN', 'L5 radiculopathy'], 'family_history': 'NC', 'present_illness': 'Ms. ___ is a very pleasant ___ ___ speaking\nwoman who presented to outpatient clinic with h/o sacral pain as \nwell as\nright what seems to be L4 distribution pain since ___. Pain \nstarted when she was lifting something heavy when she was in \n___. She got an MRI on ___ and she is coming for \nan evaluation. Overall, she says the back feels pain every now \nand then and she is describing pain in the lower lumbosacral\njunction. MRI shows multilevel disc disease and she has elected \nto undergo L3-S1 discectomies and hemi-laminectomies.', 'medications': [{'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52.8', 'valuenum': 52.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'PHYSICAL EXAM PRIOR TO ADMISSION: Range of motion of the hips is \nfine. Motor is good in both lowers extremities. Sensory is \nnormal to light touch. Reflexes 1+symmetric. \n\nDISCHARGE PHYSICAL EXAM: Her wound is clean and dry with \nsurgical staples. He leg strength is full and sensation is \nintact.', 'diagnoses': [{'icd_code': 'Z432', 'desc': 'Encounter for attention to ileostomy'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'L989', 'desc': 'Disorder of the skin and subcutaneous tissue, unspecified'}, {'icd_code': 'M359', 'desc': 'Systemic involvement of connective tissue, unspecified'}, {'icd_code': 'K660', 'desc': 'Peritoneal adhesions (postprocedural) (postinfection)'}, {'icd_code': 'K5790', 'desc': 'Diverticulosis of intestine, part unspecified, without perforation or abscess without bleeding'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}], 'summary': "Patient's outpatient MRI was notable for large right L3-L4 disc \nosteophyte, which is causing moderate to severe stenosis at that \nside and that level. That is potentially affecting again the L4 \nnerve root. Also there is a far lateral disc herniation at the \nright L5-S1 level, which\nis affecting the L5 nerve root.\nPatient was admitted to the neurosurgery service on ___ for \nelective discectomy. In the OR, patient had removal of fractured \nL5 inferior facet (was impinging on L5 nerve root), as well as \nL4-5 and L5-S1 diskectomy with nerve root decompression. She \ntolerated her procedure well with no complications and was \ntransferred to the PACU. Post-operatively she reported \nsignificant subjective improvement in her L5 radiculopathic \npain, and moved all 4 extremities with full strength. She was \ntransferred to the floor in stable condition. Pain control was \nwith dilaudid and acetaminophen. She was cleared by Physical \ntherapy. She was discharged from the hospital on ___. She \nshould return to clinic in ___ days for staple removal, and \nagain in 6 weeks for follow-up with Dr. ___ \nimaging needed)."}}
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{'final_diagnoses': ['Lumbar spinal stenosis', 'Facet fracture'], 'procedures': ['L3-4, L4-5, L5-S1 hemilaminectomies and discectomies', 'L5 facetectomy'], 'visit_summary': 'Patient was admitted to the neurosurgery service on ___ for \nelective discectomy. In the OR, patient had removal of fractured \nL5 inferior facet (was impinging on L5 nerve root), as well as \nL4-5 and L5-S1 diskectomy with nerve root decompression. She \ntolerated her procedure well with no complications and was \ntransferred to the PACU. Post-operatively she reported \nsignificant subjective improvement in her L5 radiculopathic \npain, and moved all 4 extremities with full strength. She was \ntransferred to the floor in stable condition. Pain control was \nwith dilaudid and acetaminophen. She was cleared by Physical \ntherapy. She was discharged from the hospital on ___. She \nshould return to clinic in ___ days for staple removal, and \nagain in 6 weeks for follow-up with Dr. ___ \nimaging needed).', 'medications_prescribed': ['1. Docusate Sodium 100 mg PO BID \nRX *Colace 100 mg 1 capsule(s) by mouth twice a day Disp #*60 \nTablet Refills:*0', '2. Acetaminophen 650 mg PO Q6H:PRN pain or fever', '3. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nRX *Dilaudid 2 mg ___ tablet(s) by mouth Q4hrs Disp #*90 Tablet \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Altered Mental Status', 'medical_history': ['RA', 'DM', 'Graves -> hypothyroid', 'Diplopia ___ Graves opthalmopathy)', 'Recent ankle fx (WBAT per pt)', 'Per pt had nml colonoscopy ___ yrs ago'], 'family_history': 'No h/o autoimmune dx or inflammatory bowel dx', 'present_illness': "___ y/o F PMH significant for RA, DM, hypothyroidism as a result \nof graves treatment who is brought into ED by daughter for \nalerted mental status. \nThe following history is obtained from the patient's daughter \nand husband who are the patient's bedside. \nOverall, the patient has had a slow decline in her memory over \nthe past approximately ___ years, but yet still quite functional \nin her ADLs. As a result, the daughter had her father and mother \nmove from ___ to be closer and to obtain better care for \nher RA. They have been living in an apartment. Over the past few \nmonths, the daughter has noted that her mothter's appetite has \nbeen greatly diminished leading to approximately ___ pounds of \nweight loss in about ___ months. Even when prompted, the patient \nwill refuse food. In addition, she has become more forgetful \nincluding elements of hygeine for which the family has hired an \naide to help with. The patient subsequently has had episodes \nwhere she developed abdominal pain with decreased po intake \nleading failure to thrive including ___ and hyponatremia \nrequiring admission here at ___ as well as ___ \n___. She would slowly improve during each admission without \nreturning to her ___ hospital state. On her last \nhospitalization, she was noted to have an elevated TSH to which \nher levothyroxine dose was increased to 100mg daily with some \nimprovement in her symptoms. \nThe patient's daughter noted that she was becoming increasingly \nmore somnolent over the past couple of days and unable to \nrecognize her. She was brought to her PCP where she was noted to \nhave a urinary tract infection for which she was treated with \nkeflex and completed approximately 4 doses of the antibiotic. On \n___, the patient had a large episode of diarrhea that she \nwas not aware of, which was concerning to the family. She \nadditionally was not answering questions or following commands \nlikely she typically dose. She also refused to take in any food \nor fluids. When she was becoming increasingly more somnolent she \nwas brought into the ED and was transferred to ___. Noncon \nHead Ct reportedly negative there. \nIn the ED initial vitals were:99.5 93 175/94 20 99% RA \n- Labs were significant for lactate 2.2. Chem 7 with Na 129, Cl \n91. Cr 0.6. WBC 11.9 with left shift. LFTs negative. TSH WNL. \nVitamin B12 369. Utox negative. UA with hematuria, proteinuria. \nLP was unsuccesful in the ED. NEurology evaluated the patient \nand reviewed the head CT that on their read was negative for \nacute pathology. They also recommended MRI, EEG, and empiric \ntreatment with acyclovir, vancomycin, ctx, and ampicillin. \n- Patient was given acyclovir, ctx, haldol, and vancmycin. 1L of \nIVF. \nVitals prior to transfer were:100.8 96 152/95 22 99% RA", 'medications': [{'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.6, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'STAT', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '231', 'valuenum': 231.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.44', 'valuenum': 4.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.004', 'valuenum': 1.004, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'METHADONE ASSAY DETECTS ONLY METHADONE (NOT OTHER OPIATES/OPIOIDS).'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OPIATE IMMUNOASSAY SCREEN DOES NOT DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVitals - T:98.9 BP:120/69 HR:88 RR:18 02 sat:97%RA \nGENERAL: NAD, awakes easily to voice, but falls back a sleep \nreadily \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, dry mm \nNECK: nontender supple neck unable to perform Brudzinski or \nKernig testing, no LAD, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing \nor edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: patient unable to cooperate for neuro testing \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes \n\nDischarge Physical Exam:\nVitals-98.8 86 167/98 16 98%\nGENERAL: NAD, follows commands and answers questions. AOx3 \nHEENT: AT/NC, EOMI- delayed movement of right eye as per \nbaseline, PERRL, anicteric sclera, dry mm \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi \nABDOMEN: nondistended, +BS, suprapubic tenderness, no rebound or \nguarding \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing \nor edema \nNEURO: follows commands, answers questions, AOx3, tracks \nmovement, arousable \nSKIN: warm and well perfused', 'diagnoses': [{'icd_code': '37854', 'desc': 'Sixth or abducens nerve palsy'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': "Admission Labs:\n___ 04:15PM BLOOD WBC-11.9*# RBC-4.12* Hgb-11.9* Hct-37.2 \nMCV-90 MCH-29.0 MCHC-32.1 RDW-14.9 Plt ___\n___ 04:15PM BLOOD Neuts-88.2* Lymphs-8.5* Monos-2.9 Eos-0.3 \nBaso-0.1\n___ 04:15PM BLOOD Glucose-190* UreaN-12 Creat-0.6 Na-129* \nK-3.7 Cl-91* HCO3-22 AnGap-20\n___ 05:50PM URINE Color-Yellow Appear-Clear Sp ___\n___ 05:50PM URINE Blood-LG Nitrite-NEG Protein-300 \nGlucose-300 Ketone-80 Bilirub-NEG Urobiln-2* pH-6.5 Leuks-NEG\n___ 05:50PM URINE RBC-168* WBC-1 Bacteri-NONE Yeast-NONE \nEpi-<1\n___ 05:50PM URINE Hours-RANDOM Creat-89 Na-144 K-GREATER TH \nCl-146\n\nDischarge Labs:\n___ 06:00AM BLOOD WBC-6.7 RBC-3.53* Hgb-10.3* Hct-31.6* \nMCV-90 MCH-29.3 MCHC-32.7 RDW-17.3* Plt ___\n___ 06:00AM BLOOD Glucose-150* UreaN-6 Creat-0.6 Na-135 \nK-3.9 Cl-100 HCO3-26 AnGap-13\n\nIMAGING \nMRI ___\nFINDINGS: \nThere is no intra or extra-axial mass, acute hemorrhage or acute \ninfarct. \nThere is global cerebral volume loss, within expected limits for \nthe patient's age. Multiple prominent perivascular spaces are \nseen in the basal ganglia. In addition, there are confluent \ncerebellar, pontine, subcortical and periventricular FLAIR/T2 \nwhite matter hyperintensities, which are nonspecific, but \ncommonly seen in the setting of small vessel ischemic disease. \nNo abnormal meningeal or parenchymal enhancement. The major flow \nvoids are preserved. The paranasal sinuses are essentially \nclear. Incidental note is made of bilateral lens replacements, \notherwise the orbits are unremarkable. The mastoids are \nessentially clear. \n \nIMPRESSION: \n1. No evidence of acute infarct or abnormal enhancement. No \nimaging findings to suggest HSV encephalitis. \n2. Diffuse white matter changes described above, compatible with \nsmall vessel ischemic disease. \n\n___\nFINDINGS: \nBACKGROUND: The background consists of symmetric theta range \nactivity \n(___). There is frontally maximal beta activity seen during \nthe study. \nSignificant EMG artifact is seen that limits the interpretation. \n\nHYPERVENTILATION: Could not be performed. \nINTERMITTENT PHOTIC STIMULATION: Stepped photic stimulation from \n___ flashes \nper second (fps) produces no activation of the record. \nSLEEP: No clear evidence of stage II sleep is noted. \nCARDIAC MONITOR: A single EKG channel shows a generally regular \nrhythm with \nan average rate of 75-85 bpm. \nIMPRESSION: This is an abnormal routine EEG because of diffuse \nbackground \nslowing. This finding is indicative of a moderate diffuse \nencephalopathy \nwhich implies widespread cerebral dysfunction but is \nnon-specific as to \netiology. No focal or epileptiform features are seen.\n___ y/o F PMH significant for RA, DM, hypothyroidism as a result \nof graves treatment who is admitted for altered mental status \nsecondary to a urinary tract infection. \n\nACUTE MEDICAL ISSUES\n#Altered Mental Status: Originally suspected to have \nmeningitis/encephalitis, however did well after short course of \nempiric therapy. Unable to obtain LP during hospital stay. \nStarted on empiric treatment. MRI performed and was normal. \nNeuro had seen the patient as well and assisted with guidance of \ntherapy. EEG showed no seizure activity and was normal. Patients \nmental status started to improve, empiric therapies were \ndiscontinued and patient was continued to be treated for UTI. \nUltimately, suspect UTI as cause of altered mental status. \nSymptoms resolved and patient returned to baseline and was \nconfirmed by her daughter. \n\n#Urinary Tract Infection: Patient was being treated as an \noutpatient for UTI with keflex prior to admission. Follow up \nfrom culture was pansensitive. After empiric antibiotics were \ntaken off patient was started on ciprofloxacin with a goal to \ntreat of a total of 10 days. Last day of cipro will be ___. \n\n#Hyponatremia- Patient was noted to be hyponatremic secondary to \nhypovolemia on admission secondary to poor PO intake which \ncorrected with IVF. \n\nCHRONIC MEDICAL ISSUES\n# hypothyroidism: continued on home dose of levothyroxine \n# Diabetes Mellitus: metformin was held during hospital stay. \nPatient switched to sliding scale. Restarted metformin on \ndischarge. \n\nTRANSITIONAL CARE \n# As per the family patient has had a chronic decline in mental \nfunction. Further work up for this is warranted as an \noutpatient.\n# UTI- family notes patient may be having repeat urinary tract \ninfections. This may warrant further work up. Otherwise \ntreatment as above."}}
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{'final_diagnoses': ['Altered Mental Status', 'Urinary tract infection'], 'procedures': ['None'], 'visit_summary': '___ y/o F PMH significant for RA, DM, hypothyroidism as a result \nof graves treatment who is admitted for altered mental status \nsecondary to a urinary tract infection. \n\nACUTE MEDICAL ISSUES\n#Altered Mental Status: Originally suspected to have \nmeningitis/encephalitis, however did well after short course of \nempiric therapy. Unable to obtain LP during hospital stay. \nStarted on empiric treatment. MRI performed and was normal. \nNeuro had seen the patient as well and assisted with guidance of \ntherapy. EEG showed no seizure activity and was normal. Patients \nmental status started to improve, empiric therapies were \ndiscontinued and patient was continued to be treated for UTI. \nUltimately, suspect UTI as cause of altered mental status. \nSymptoms resolved and patient returned to baseline and was \nconfirmed by her daughter. \n\n#Urinary Tract Infection: Patient was being treated as an \noutpatient for UTI with keflex prior to admission. Follow up \nfrom culture was pansensitive. After empiric antibiotics were \ntaken off patient was started on ciprofloxacin with a goal to \ntreat of a total of 10 days. Last day of cipro will be ___. \n\n#Hyponatremia- Patient was noted to be hyponatremic secondary to \nhypovolemia on admission secondary to poor PO intake which \ncorrected with IVF. \n\nCHRONIC MEDICAL ISSUES\n# hypothyroidism: continued on home dose of levothyroxine \n# Diabetes Mellitus: metformin was held during hospital stay. \nPatient switched to sliding scale. Restarted metformin on \ndischarge. \n\nTRANSITIONAL CARE \n# As per the family patient has had a chronic decline in mental \nfunction. Further work up for this is warranted as an \noutpatient.\n# UTI- family notes patient may be having repeat urinary tract \ninfections. This may warrant further work up. Otherwise \ntreatment as above.', 'medications_prescribed': ['Levothyroxine Sodium 100 mcg PO DAILY', 'Ciprofloxacin HCl 500 mg PO Q12H Duration: 4 Days', 'Docusate Sodium (Liquid) 100 mg PO BID:PRN constipation', 'Aspirin 81 mg PO DAILY', 'MetFORMIN (Glucophage) 1000 mg PO BID', 'Heparin 5000 UNIT SC TID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 32, 'gender': 'F', 'symptoms': 'Dyspnea on exertion, fatigue', 'medical_history': ['Depression', 'Erectile Dysfunction', 'Gastroesophageal Reflux Disease', 'Mitral Regurgitation', 'Mitral Valve Prolapse', 'Reactive Airway Disease'], 'family_history': 'No premature history of coronary artery disease.', 'present_illness': 'Mr. ___ is a ___ year old man with a new diagnosis of mitral \nvalve prolapse\nand mitral regurgitation. He presented to his primary care \nprovider in ___ for a routine exam. It had been some time \nsince he had been seen by a provider. A murmur was noted and he \nwas referred on to Dr. ___ workup. A transesophageal \nechocardiogram revealed a moderately dilated left atrium, normal \nleft ventricular function, and a partially flail mitral leaflet \nwith severe mitral regurgitation. He also underwent a cardiac \ncatheterization which\ndemonstrated minimal coronary artery disease. He presents today \nto\ndiscuss mitral valve surgery. Currently, he feels well. He noted \nexertional dyspnea and fatigue. He denied atrial fibrillation, \nchest pain, orthopnea, paroxysmal nocturnal dyspnea, and pedal \nedema.', 'medications': [{'medication': 'Cepacol (Menthol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vital Signs sheet entries for ___:\nBP: 117/64. Heart Rate: 70. Resp. Rate: 12. O2 Saturation%: 98.\nHeight: 70" Weight: 190 lbs BSA: 2.06 m2\n\nGeneral: WDWN. Mildly anxious. \nSkin: Warm, Dry and intact\nHEENT: NCAT, PERRLA, EOMI, Sclera anicteric, OP benign. Teeth in \npoor repair. \nNeck: Supple [X] Full ROM [X]\nChest: Lungs clear bilaterally [X]\nHeart: RRR, Nl S1-S2, IV/VI holosystolic murmur loudest at apex. \n\nAbdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds \n+ [X]\nExtremities: Warm [X], well-perfused [X] No Edema\nVaricosities: None [X]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: 2 Left: 2\nDP Right: 2 Left: 2\n___ Right: 2 Left: 2\nRadial Right: 2 Left: 2\n\nCarotid Bruit: faint transmission of murmur\n\nDischarge Examination \n98.5-139/67-66-20-100% RA wt 91.4 kg\nAlert and oriented x3 no focal deficits \nRRR no murmur rub or gallops \nClear decreased throughout no wheezes or rhonchi \nAbdomen soft nontender and nondistended \nExtremities warm no edema \nSternal incision healing no erythema or drainage', 'diagnoses': [{'icd_code': '63310', 'desc': 'Tubal pregnancy without intrauterine pregnancy'}, {'icd_code': '65413', 'desc': 'Tumors of body of uterus, antepartum condition or complication'}, {'icd_code': '2189', 'desc': 'Leiomyoma of uterus, unspecified'}, {'icd_code': 'V6441', 'desc': 'Laparoscopic surgical procedure converted to open procedure'}], 'summary': 'Transesophageal Echocardiogram ___\n \nPREBYPASS \nNo atrial septal defect is seen by 2D or color Doppler. Left \nventricular wall thicknesses are normal. The left ventricular \ncavity is severely dilated. Regional left ventricular wall \nmotion is normal. Overall left ventricular systolic function is \nnormal (LVEF>55%). [Intrinsic left ventricular systolic function \nis likely more depressed given the severity of valvular \nregurgitation.] Right ventricular chamber size and free wall \nmotion are normal. The ascending, transverse and descending \nthoracic aorta are normal in diameter.. The aortic valve \nleaflets (3) are mildly thickened. No aortic regurgitation is \nseen. The mitral valve leaflets are mildly thickened. There is \npartial posterior mitral leaflet flail. An eccentric, anteriorly \ndirected jet of Severe (4+) mitral regurgitation is seen. \n\nPOSTBYPASS\nBiventricular systolic function remains preserved. There is an \nannuloplasty ring in the mitral position. MV coaptation appears \nnormal. There is no residual MR. ___ is no ___ of the MV \nleaflets. The study is otherwise unchanged from prebypass. \n\n___ 07:15AM BLOOD Hct-27.4*\n___ 06:45AM BLOOD WBC-5.5 RBC-2.78* Hgb-8.4* Hct-23.8* \nMCV-86 MCH-30.3 MCHC-35.3* RDW-13.2 Plt ___\n___ 11:38AM BLOOD WBC-20.9*# RBC-3.40*# Hgb-10.5*# \nHct-29.6*# MCV-87 MCH-30.9 MCHC-35.5* RDW-13.6 Plt ___\n___ 07:15AM BLOOD ___\n___ 11:38AM BLOOD ___ PTT-30.4 ___\n___ 11:38AM BLOOD ___\n___ 07:15AM BLOOD Na-137 K-4.5 Cl-99\n___ 06:45AM BLOOD Glucose-115* UreaN-16 Creat-1.1 Na-138 \nK-4.4 Cl-99 HCO3-28 AnGap-15\n___ 01:37PM BLOOD UreaN-14 Creat-1.0 Na-142 K-3.4 Cl-109* \nHCO3-25 AnGap-11\n___ 07:15AM BLOOD Mg-2.2\n\nCXR \nPreviously seen mild atelectasis the right lung base has been \nresolved. There is no lung consolidation. There are minimal \nbilateral pleural effusions. Cardiomediastinal silhouette is \nunchanged. Mediastinal wires and prosthetic antral valve is \nconsistent with history of mitral valve repair. Small amount of \nair is noted in the anterior mediastinum.\nPresented on day of surgery and was taken to the operating \nroom. He underwent mitral valve repair, please see operative \nreport for further details. He was noted for significant \nnarcotic requirements during surgery and there was question of \nsuboxone use prior to admission. Pain service was consulted and \nhe was taken to the intensive care unit for post operative \nmanagement. He was weaned from sedation, awoke neurologically \nintact and was extubated. Pain medications were adjusted in \nconjunction with pain service. He required neosynephrine for \nhypotension which was weaned off the morning of post operative \nday one. He continued to progress and was transferred to the \nfloor post operative day one. \nHe was started on low dose betablocker and diuretic. On post \noperative day two he developed atrial fibrillation that was \ntreated with betablockers and he returned to ___. Pacing wires \nand chest tubes were removed without indicent. He again \ndeveloped rapid atrial fibrillation and amiodarone and coumadin \nwere started. He converted to sinus rhythm. Physical therapy \nworked on strength and mobility with recommendation for home \nwith services. On day of discharge had long discussion with him \nin relation to pain management and to avoid use of street \nmedications which he was in agreement. He has choosen to follow \nup with pain clinic at ___ and that has been arranged from \n___. HE has been supplied with oxycodone and valium \nprescriptions that will cover him until his pain clinic follow \nup and any further prescriptions will be through pain clinic. \nPrimary care was also contacted and updated on plan. He was \nready for discharge home post operative day six with services.'}}
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{'final_diagnoses': ['Mitral Regurgitation and Prolapse s/p mitral valve repair', 'Post operative atrial fibrillation', 'Acute on chronic pain', 'Depression', 'Erectile Dysfunction', 'Gastroesophageal Reflux Disease', 'Reactive Airway Disease'], 'procedures': ['Mitral valve repair 32 mm ring and resection P2 leaflet ___'], 'visit_summary': 'Presented on day of surgery and was taken to the operating \nroom. He underwent mitral valve repair, please see operative \nreport for further details. He was noted for significant \nnarcotic requirements during surgery and there was question of \nsuboxone use prior to admission. Pain service was consulted and \nhe was taken to the intensive care unit for post operative \nmanagement. He was weaned from sedation, awoke neurologically \nintact and was extubated. Pain medications were adjusted in \nconjunction with pain service. He required neosynephrine for \nhypotension which was weaned off the morning of post operative \nday one. He continued to progress and was transferred to the \nfloor post operative day one. \nHe was started on low dose betablocker and diuretic. On post \noperative day two he developed atrial fibrillation that was \ntreated with betablockers and he returned to ___. Pacing wires \nand chest tubes were removed without indicent. He again \ndeveloped rapid atrial fibrillation and amiodarone and coumadin \nwere started. He converted to sinus rhythm. Physical therapy \nworked on strength and mobility with recommendation for home \nwith services. On day of discharge had long discussion with him \nin relation to pain management and to avoid use of street \nmedications which he was in agreement. He has choosen to follow \nup with pain clinic at ___ and that has been arranged from \n___. HE has been supplied with oxycodone and valium \nprescriptions that will cover him until his pain clinic follow \nup and any further prescriptions will be through pain clinic. \nPrimary care was also contacted and updated on plan. He was \nready for discharge home post operative day six with services.', 'medications_prescribed': ['1. Aspirin EC 81 mg PO DAILY', '2. Amiodarone 400 mg PO BID \n___ twice a day for 5 days then decrease to 400 mg daily for 7 \ndays then decrease to 200 mg daily \nRX *amiodarone 200 mg 2 tablet(s) by mouth twice a day Disp #*50 \nTablet Refills:*1', '3. Diazepam 5 mg PO Q6H:PRN anxiety \nRX *diazepam 5 mg 1 mg by mouth twice a day Disp #*14 Tablet \nRefills:*0', '___ MD to order daily dose PO DAILY \nRX *warfarin [___] 2 mg ___ tablet(s) by mouth once a day \nDisp #*90 Tablet Refills:*1', '5. Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*30 \nCapsule Refills:*0', '6. Gabapentin 600 mg PO TID \nRX *gabapentin 600 mg 1 tablet(s) by mouth three times a day \nDisp #*90 Tablet Refills:*1', '7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nplease continue to taper down on dose \nRX *oxycodone 5 mg ___ capsule(s) by mouth every four (4) hours \nDisp #*50 Capsule Refills:*0\nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*90 Tablet Refills:*0', '8. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*60 Capsule Refills:*1', '9. Metoprolol Tartrate 50 mg PO TID \nRX *metoprolol tartrate 50 mg 1 tablet(s) by mouth three times a \nday Disp #*90 Tablet Refills:*1', '10. Furosemide 20 mg PO DAILY Duration: 7 Days \nRX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*7 \nTablet Refills:*0', '11. Polyethylene Glycol 17 g PO DAILY \nhold for loose stools \nRX *polyethylene glycol 3350 17 gram/dose 17 gram by mouth once \na day Disp #*30 Packet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 79, 'gender': 'M', 'symptoms': 'Pt admitted for ileostomy closure', 'medical_history': ['Hypertension', 'Right colonic polyp', 'Diverticulitis, Rectosigmoidectomy and anastomosis ___', 'Ileostomy and repair of anastomotic leak ___', 'Partial Small Bowel Obstruction ___'], 'family_history': 'noncontributory', 'present_illness': 'Mr. ___ is a ___ male with a past medical/surgical history \nsignificant for hypertension, right colonic polyp, \ndiverticulitis, rectosigmoidectomy and anastomosis ___, \nileostomy and repair of anastomotic leak ___, \npartial Small bowel obstruction ___. \nMr. ___ underwent ___ anterior resection on ___ for \nrecurrent diverticulitis. This was complicated by a readmission \nconcerning for anastamotic leak, and underwent an ex-lap on ___ \nwith the finding of an intact anastamosis, and creation of a \ndiverting ileostomy. He presented ___ for closure of his \nileostomy.\nMr. ___ was admitted to ___ from the ___. V.S.S: \n98.6, 83, 129/88, 18, 98% 2l.', 'medications': [{'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.5, . estimated GFR (eGFR) is likely between 45 and 55 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'At Discharge:\nVitals: 98.5, 70, 119/71, 20, 98% RA\nGEN: No apparent distress, alert and oriented times 3\nCV: RRR, no m/r/g\nRESP: CTAB\nABD: soft, ND, +BS, +flatus, appropriately tender to palpation \nIncision: right ___ quadrent with incision open to air with \nstaples, no signs or symptoms of infection. \nExtrem: no c/c/e', 'diagnoses': [{'icd_code': 'S42022A', 'desc': 'Displaced fracture of shaft of left clavicle, initial encounter for closed fracture'}, {'icd_code': 'S301XXA', 'desc': 'Contusion of abdominal wall, initial encounter'}, {'icd_code': 'S32058A', 'desc': 'Other fracture of fifth lumbar vertebra, initial encounter for closed fracture'}, {'icd_code': 'V4352XA', 'desc': 'Car driver injured in collision with other type car in traffic accident, initial encounter'}, {'icd_code': 'Y9289', 'desc': 'Other specified places as the place of occurrence of the external cause'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'R001', 'desc': 'Bradycardia, unspecified'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'Z85038', 'desc': 'Personal history of other malignant neoplasm of large intestine'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'N289', 'desc': 'Disorder of kidney and ureter, unspecified'}, {'icd_code': 'M109', 'desc': 'Gout, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z8614', 'desc': 'Personal history of Methicillin resistant Staphylococcus aureus infection'}], 'summary': "___ 08:15AM BLOOD WBC-7.2 RBC-3.05* Hgb-10.3* Hct-29.0* \nMCV-95 MCH-33.8* MCHC-35.5* RDW-17.9* Plt ___\n___ 08:15AM BLOOD Glucose-109* UreaN-12 Creat-1.0 Na-142 \nK-4.3 Cl-108 HCO3-27 AnGap-11\n___ 08:15AM BLOOD Calcium-8.5 Phos-3.6 Mg-2.0\n.\nPathology Examination \nProcedure date ___\nClinical: Diverticulitis.\nPatient was admitted to the ___ from the PACU following \nan Ileostomy closure. Pt's vital signs were stable upon arrival \nto the floor 98.6, 83, 129/88, 18, 98% 2L. Pt denied nausea, \nvomitting, flatus. Urine output was good. \n\n___ - ___ stated his pain was not well controlled with \nmorphine PCA 1.5 mg Lockout Interval: 6 minutes Basal Rate: 0 \nmg(s)/hour 1-hr Max Limit: 15 mg(s). PCA was changed to \nHYDROmorphone (Dilaudid) 0.25 mg IVPCA Lockout Interval: 6 \nminutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 2.5 mg(s), pt \nalso stated that this was not providing adequate pain control. \nPt was administered IV fluids and tolerating sips. \n\n___ - Pt's diet was increased to clears and his IVF were \ndiscontinued once he tolerated > 400 cc's. He was then increased \nto a low residue diet after passing flatus, tolerated well and \noral medications were restarted. Pt's pain was well controlled \nwith Oxycodone ___ mg PO Q4H:PRN pain and acetaminophen \n___ mg Q6H:PRN. Pt was provided with handout regarding a \nlow residue diet. \n\n___ - V.S.S- 98.5, 70, 119/71, 20, 98% RA, tolerating low \nresidue diet, pain well controlled with oral medications and \nincision open to air with staples, no signs/symptoms of \ninfection. Pt states he has + flatus, however he has not had a \nbowel movement. Pt discharged home without services. Discharge \ninstructions reviewed with pt, including need of resuming \nLoperamide/Lomotil if stools become excessive and loose. Advised \nto consult with Dr. ___. He will follow-up with \nDr. ___ in ___ weeks for staple removal."}}
|
{'final_diagnoses': ['Ileostomy closure', 'Small Bowel Obstruction ___', 'diverticulitis', 'hypertension', 'Right colon polyp'], 'procedures': ['Ileostomy closure'], 'visit_summary': "Patient was admitted to the ___ from the PACU following \nan Ileostomy closure. Pt's vital signs were stable upon arrival \nto the floor 98.6, 83, 129/88, 18, 98% 2L. Pt denied nausea, \nvomitting, flatus. Urine output was good. \n\n___ - ___ stated his pain was not well controlled with \nmorphine PCA 1.5 mg Lockout Interval: 6 minutes Basal Rate: 0 \nmg(s)/hour 1-hr Max Limit: 15 mg(s). PCA was changed to \nHYDROmorphone (Dilaudid) 0.25 mg IVPCA Lockout Interval: 6 \nminutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 2.5 mg(s), pt \nalso stated that this was not providing adequate pain control. \nPt was administered IV fluids and tolerating sips. \n\n___ - Pt's diet was increased to clears and his IVF were \ndiscontinued once he tolerated > 400 cc's. He was then increased \nto a low residue diet after passing flatus, tolerated well and \noral medications were restarted. Pt's pain was well controlled \nwith Oxycodone ___ mg PO Q4H:PRN pain and acetaminophen \n___ mg Q6H:PRN. Pt was provided with handout regarding a \nlow residue diet. \n\n___ - V.S.S- 98.5, 70, 119/71, 20, 98% RA, tolerating low \nresidue diet, pain well controlled with oral medications and \nincision open to air with staples, no signs/symptoms of \ninfection. Pt states he has + flatus, however he has not had a \nbowel movement. Pt discharged home without services. Discharge \ninstructions reviewed with pt, including need of resuming \nLoperamide/Lomotil if stools become excessive and loose. Advised \nto consult with Dr. ___. He will follow-up with \nDr. ___ in ___ weeks for staple removal.", 'medications_prescribed': ['1. Lisinopril 10 mg Tablet Sig: Three (3) Tablet PO BID (2 times \na day). ', '2. Acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain/HA. ', '3. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO every twelve (12) hours. ', '4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '5. Oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) \nas needed for pain for 2 weeks.\nDisp:*45 Tablet(s)* Refills:*0*', '6. Diphenoxylate-Atropine 2.5-0.025 mg Tablet Sig: One (1) \nTablet PO PRN as needed for Loose stools. Advised to HOLD until \nnormal bowel pattern resumes. ']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 81, 'gender': 'M', 'symptoms': 'posterior cervical insicion pain', 'medical_history': ['MRSA', 'Chronic radiculopathy'], 'family_history': 'N/A', 'present_illness': '___ yo male patient with chronic radiculopathy and regoin pain \nsyndrome who underwent a cervical spinal cord stimulator on \n___. He returns with intractable, uncontrolled incisional \npain. He was admitted for pain control and further work up.', 'medications': [{'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dabigatran Etexilate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dipyridamole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '1.034', 'valuenum': 1.034, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': ';METHADONE ASSAY DETECTS METHADONE (NOT OTHER OPIATES/OPIOIDS);QUETIAPINE (SEROQUEL) MAY CAUSE A FALSE POSITIVE RESULT;.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': ';OPIATE ASSAY DOES NOT RELIABLY DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}, {'value': '___', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.5', 'valuenum': 56.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Exam on admission:\nExam: 97.9 136/91 18 ___\nNCAT\nRRR \nClear S1/2 \nAbd S/ND\nWWP, no CCE\nIncision: mild erythema around incision site (sutures), TTP,\nfirm, no fluctuance, no purulent material\n\nNeuro exam\nOriented x 3. Spells world forwards but declines to spell it\nbackwards. Declines to do serial 7s. Registration ___ and recall\n___. \nCN II-XII intact\nStrength ___ except 4+/5 in LUE (limited effort)\nSensory: decreased sensation to pinprick along ulnar surface of\npalmar hand/fingers, all aspects of forearm except anterior\naspect; temperature and proprioception normal\nReflexes: 2+ throughout', 'diagnoses': [{'icd_code': '4370', 'desc': 'Cerebral atherosclerosis'}, {'icd_code': '4358', 'desc': 'Other specified transient cerebral ischemias'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': '44021', 'desc': 'Atherosclerosis of native arteries of the extremities with intermittent claudication'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V422'}, {'icd_code': '31089', 'desc': 'Other specified nonpsychotic mental disorders following organic brain damage'}, {'icd_code': '72989', 'desc': 'Other musculoskeletal symptoms referable to limbs'}], 'summary': 'He labs showed no leukocytosis, he had an \nelevated CRP at 35.\nOn ___, the patient had presented on ___ with \ncomplaints of uncontrolled incisional pain and wound erythema \nafter having a spinal cord stimulator placed on ___. He \nstates the pain is only at the incision site, in nonradiating, \nand denies any fevers or chills. He was admitted for further \nwork up and managment of his pain. He was started on as needed \nflexeril for spasm and his as needed oxycodone was increased to \n___ po every 3 hours as needed for pain. Additionally \nchronic pain was consulted to weigh in on managing his acote on \nchronic pain. He labs showed no leukocytosis, he had an \nelevated CRP at 35. His wound shows some mild erythema and \ninduration at the superior, right aspect, without any drainage.\n\nOn ___, the patient was much more comfortable after his pain \nmedication was changed to Dilaudid by Chronic Pain Service. He \ncontinued to have some redness and swelling around the wound, \nhowever, the swelling is improved. He has remain afebrile and \nhis vancomycin will be discontinued affter his 1600 dose. He was \ndischarged home.'}}
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{'final_diagnoses': ['Acute on chronic pain', 'Question of wound infection'], 'procedures': ['s/p cervical spinal cord stimulator ___'], 'visit_summary': 'On ___, the patient had presented on ___ with \ncomplaints of uncontrolled incisional pain and wound erythema \nafter having a spinal cord stimulator placed on ___. He \nstates the pain is only at the incision site, in nonradiating, \nand denies any fevers or chills. He was admitted for further \nwork up and managment of his pain. He was started on as needed \nflexeril for spasm and his as needed oxycodone was increased to \n___ po every 3 hours as needed for pain. Additionally \nchronic pain was consulted to weigh in on managing his acote on \nchronic pain. He labs showed no leukocytosis, he had an \nelevated CRP at 35. His wound shows some mild erythema and \ninduration at the superior, right aspect, without any drainage.\n\nOn ___, the patient was much more comfortable after his pain \nmedication was changed to Dilaudid by Chronic Pain Service. He \ncontinued to have some redness and swelling around the wound, \nhowever, the swelling is improved. He has remain afebrile and \nhis vancomycin will be discontinued affter his 1600 dose. He was \ndischarged home.', 'medications_prescribed': ['Gabapentin 1600 mg PO DAILY', 'Gabapentin 800 mg PO NOON', 'Gabapentin 1600 mg PO QHS', 'HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nRX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every \nfour (4) hours Disp #*80 Tablet Refills:*0', 'Methadone 20 mg PO TID', 'Nortriptyline 75 mg PO QHS', 'Cyclobenzaprine 5 mg PO TID:PRN muscle spasm \nRX *cyclobenzaprine 5 mg 1 tablet(s) by mouth three times a day \nDisp #*50 Tablet Refills:*0', 'Acetaminophen 650 mg PO Q6H']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 68, 'gender': 'M', 'symptoms': 'Fever,Nausea', 'medical_history': ['- Type 1 DM', '- HTN', '- Hypothyroidism', '- HLD', '- Anemia', '- Asthma'], 'family_history': '"Father died at age ___ of CAD. His first MI occurred at ___. He \nalso had type 2 diabetes and rheumatoid arthritis. Mother is \nalive. She is ___ now. She had recurrent peptic ulcer disease \nrequiring vagotomy. Older brother ___ and \nhypertension. Second brother without condition. Third brother \nwith hypertension. Younger sister alive and well."', 'present_illness': 'This is a ___ with history of T1DM, HTN, Hypothyroidism who \npresents with fever and nausea. Nausea began 1 day PTA however \ndenies any vomiting, abdominal pain, changes in bowel patterns, \neating exotic foods, or recent travel. Denies having anginal \nsymptoms in the past however reports having SOB once several \nyears which prompted stress test and ultimately catheterization, \nwhich did not result in intervention. \nAlso reports fevers intermittent for the last 3 weeks, with \nhighest reported fever being 102 weeks prior to admission. \nStates that she gets fevers about twice a week, occuring at any \npoint during the day. Has associated chills and sweats (although \nnot drenching). Denies changes in weight. Denies any localizing \nsymptoms including headaches, sinus or face pain, URI symptoms, \ncough, SOB, chest pain, palpitations, vomiting, abdominal pain, \nchanges in bowel habits, rashes, joint stiffness/swelling ___ \nswelling. Reports never having had a colonoscopy and last \nmammogram being ___ years ago with reportedly "normal" results. \nLast fever was on day of presentation. \nShe however did endorse left shoulder pain. This was first \nreported in ___ however she states that it worsened over the \nlast 6 months and intensified over the last ___ days, coinciding \nwith the onset of her nausea. Denies any recent trauma or \nprecipitating event that would exacerbated the pain. States that \npain escalated such that she would awake from sleep with pain. \nGiven her constellation of symptoms, she presented to the ED for \nevaluation. \nIn the ED, initial vs were: 98 105 145/78 18 100% ra. Evaluation \nwas significant for shoulder tenderness. Labs were remarkable \nfor WBC 20.5 (93.8%N), Gluc 200 (AG 10), Lactate 1.3, CRP 11.2, \nand ESR 6. Patient underwent CXR and shoulder xray which did not \nany acute process. Orthopedics was consult given shoulder pain, \nfevers, and WBC who performed an arthrocentesis which revealed \n12 WBC and >11k RBCs. Patient was given morphine 5mg IV x 2, and \npercocet x 1. Patietn was then admitted to medicine for further \nwork-up. Vitals on Transfer: 97.6 59 127/65 16 100% \n\nOn the floor, patient was complaining of nausea.', 'medications': [{'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'NIFEdipine (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fleet Enema (Saline)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fondaparinux', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mouth Care Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bivalirudin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Epoprostenol (Veletri)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Fondaparinux', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CARVedilol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fondaparinux', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fondaparinux', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Epoprostenol (Veletri)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears GEL 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Fondaparinux', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bivalirudin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bivalirudin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Epoprostenol (Veletri)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Clevidipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Bivalirudin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Clevidipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Artificial', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fondaparinux', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Nystatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mouth Care Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'NORepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'AcetaZOLamide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Valproate Sodium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Epoprostenol (Veletri)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CARVedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.76', 'valuenum': 0.76, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81.5', 'valuenum': 81.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.00', 'valuenum': 1.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.08', 'valuenum': 8.08, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '54.8', 'valuenum': 54.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.1', 'valuenum': 19.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.5', 'valuenum': 53.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '54.7', 'valuenum': 54.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 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'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 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'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 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'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58.0', 'valuenum': 58.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 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'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.98, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 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'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61.7', 'valuenum': 61.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.27', 'valuenum': 7.27, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '45', 'valuenum': 45.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': '<5.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 500.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 229.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63.8', 'valuenum': 63.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 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'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '76', 'valuenum': 76.0, 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'comments': '___'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '264', 'valuenum': 264.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63.7', 'valuenum': 63.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 67.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.024', 'valuenum': 1.024, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hazy*.'}, {'value': 'YELLOW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.01', 'valuenum': 1.01, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '270', 'valuenum': 270.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.89', 'valuenum': 2.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '64.4', 'valuenum': 64.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'Verified By Dilution.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Lipemia affects this test. Verified By Dilution.'}, {'value': '___', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.3, . estimated GFR (eGFR) is likely between 55 and 67 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '285', 'valuenum': 285.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.2', 'valuenum': 21.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '65.6', 'valuenum': 65.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '289', 'valuenum': 289.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.06', 'valuenum': 3.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '66.1', 'valuenum': 66.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '330', 'valuenum': 330.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.2', 'valuenum': 21.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.82', 'valuenum': 2.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67.2', 'valuenum': 67.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '435', 'valuenum': 435.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 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'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SM*.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 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None}, {'value': '341', 'valuenum': 341.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.88', 'valuenum': 2.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67.2', 'valuenum': 67.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 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'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, 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'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '60.0', 'valuenum': 60.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '537', 'valuenum': 537.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.64', 'valuenum': 1.64, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75.0', 'valuenum': 75.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '519', 'valuenum': 519.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.81', 'valuenum': 0.81, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.01', 'valuenum': 8.01, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76.0', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 157.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '55.8', 'valuenum': 55.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54.7', 'valuenum': 54.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.4, . estimated GFR (eGFR) is likely between 51 and 61 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56.1', 'valuenum': 56.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'QNS TO VERIFY. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.02', 'valuenum': 1.02, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.52', 'valuenum': 7.52, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52.5', 'valuenum': 52.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '53.0', 'valuenum': 53.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '515', 'valuenum': 515.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': '___'}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 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'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.8', 'valuenum': 21.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '427', 'valuenum': 427.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.6', 'valuenum': 87.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 151.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '128', 'valuenum': 128.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '___', 'valuenum': 154.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '381', 'valuenum': 381.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.10', 'valuenum': 3.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.4', 'valuenum': 87.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '402', 'valuenum': 402.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83.7', 'valuenum': 83.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '350', 'valuenum': 350.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.10', 'valuenum': 3.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.8', 'valuenum': 79.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '371', 'valuenum': 371.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.8', 'valuenum': 21.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76.7', 'valuenum': 76.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '382', 'valuenum': 382.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75.7', 'valuenum': 75.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '332', 'valuenum': 332.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '347', 'valuenum': 347.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74.8', 'valuenum': 74.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '320', 'valuenum': 320.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.49', 'valuenum': 3.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74.2', 'valuenum': 74.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}], 'exams': 'admission\nVitals: 98.0 179/104 (144/70) 83 18 96% RA 263 \nGeneral: Alert, oriented, mildly uncomfortable appearing \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema; restricted L shoulder ROM ___ pain, pain equal in both \npassive and active motion, no obvious effusion on exam, mildly \nwarm, tenderness elicited along bicipital groove \nSkin: no rashes \nNeuro: AAOx3, CNII-XII grossly intact, ___ strength, sensation \ngrossly intact \n.\ndischarge\nVS: 98.7 98.2 84 126/62 16 99%RA\nGeneral: Alert, oriented, mildly uncomfortable appearing \nHEENT: Sclera anicteric, MMM\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present\nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema; restricted L shoulder ROM ___ pain, pain equal in both \npassive and active motion with extension and adduction, no \nobvious effusion on exam, mildly warm, no tenderness with \npalpation of the joint. \nSkin: no rashes \nNeuro: AAOx3, grossly intact', 'diagnoses': [{'icd_code': 'T82898A', 'desc': 'Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter'}, {'icd_code': 'I713', 'desc': 'Abdominal aortic aneurysm, ruptured'}, {'icd_code': 'T80211A', 'desc': 'Bloodstream infection due to central venous catheter, initial encounter'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'R578', 'desc': 'Other shock'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'J90', 'desc': 'Pleural effusion, not elsewhere classified'}, {'icd_code': 'Q211', 'desc': 'Atrial septal defect'}, {'icd_code': 'F05', 'desc': 'Delirium due to known physiological condition'}, {'icd_code': 'J811', 'desc': 'Chronic pulmonary edema'}, {'icd_code': 'T17890A', 'desc': 'Other foreign object in other parts of respiratory tract causing asphyxiation, initial encounter'}, {'icd_code': 'J9811', 'desc': 'Atelectasis'}, {'icd_code': 'D6861', 'desc': 'Antiphospholipid syndrome'}, {'icd_code': 'J95851', 'desc': 'Ventilator associated pneumonia'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'E873', 'desc': 'Alkalosis'}, {'icd_code': 'E870', 'desc': 'Hyperosmolality and hypernatremia'}, {'icd_code': 'Y832', 'desc': 'Surgical operation with anastomosis, bypass or graft as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'I724', 'desc': 'Aneurysm of artery of lower extremity'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'I739', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'R680', 'desc': 'Hypothermia, not associated with low environmental temperature'}, {'icd_code': 'Z89511', 'desc': 'Acquired absence of right leg below knee'}, {'icd_code': 'G40909', 'desc': 'Epilepsy, unspecified, not intractable, without status epilepticus'}, {'icd_code': 'X58XXXA', 'desc': 'Exposure to other specified factors, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'K660', 'desc': 'Peritoneal adhesions (postprocedural) (postinfection)'}, {'icd_code': 'B9689', 'desc': 'Other specified bacterial agents as the cause of diseases classified elsewhere'}, {'icd_code': 'Y848', 'desc': 'Other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}, {'icd_code': 'R34', 'desc': 'Anuria and oliguria'}, {'icd_code': 'E806', 'desc': 'Other disorders of bilirubin metabolism'}, {'icd_code': 'T82868A', 'desc': 'Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter'}], 'summary': "admission:\n\n___ 06:00PM BLOOD WBC-20.5*# RBC-4.52 Hgb-13.6 Hct-40.6 \nMCV-90 MCH-30.1 MCHC-33.5 RDW-13.1 Plt ___\n___ 06:00PM BLOOD Glucose-200* UreaN-12 Creat-0.8 Na-139 \nK-4.1 Cl-101 HCO3-28 AnGap-14\n___ 06:00PM BLOOD Calcium-9.4 Phos-3.7 Mg-1.9\n___ 06:00PM BLOOD CK-MB-2 cTropnT-<0.01\n___ 05:45AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 06:00PM BLOOD Lipase-24\n___ 06:00PM BLOOD CRP-11.2*\n___ 06:01PM BLOOD Lactate-1.3\n___ 06:00PM BLOOD ESR-6\n.\n\n- CXR (___): No signs of pneumonia. \n- L Shoulder XR (___): Three views of the left shoulder were \nprovided demonstrating no acute fracture or dislocation. There \nis no significant degenerative disease. Soft tissues are normal. \nAlignment at the left AC joint appears anatomic and similar to \nthe contralateral side as assessed on a prior right shoulder \nradiograph dated ___. \n- L Shoulder MR (___): Wetread--No osteomyelitis. No septic \narthritis.\n.\ndischarge:\n\n___ 06:20AM BLOOD WBC-5.1# RBC-4.06* Hgb-11.9* Hct-36.7 \nMCV-91 MCH-29.4 MCHC-32.4 RDW-12.9 Plt ___\n___ 06:20AM BLOOD Glucose-178* UreaN-8 Creat-0.7 Na-144 \nK-3.7 Cl-103 HCO3-34* AnGap-___ with history of T1DM, HTN, Hypothyroidism who presents \nwith 3 weeks of fevers/chills with acute worsening x1 day with \nfevers, chills, nausea, malaise in context of 6 months of left \nshoulder pain, w/o evid for septic joint or osteo.\n# Fever/Leukocytosis: Unclear etiology; has not had fevers here \nand borderline leukocytosis has normalized raising possibility \nof stress response. Shoulder exam and XR are benign as was tap, \nsuggesting this is neither osteo nor septic arthritis assoc with \nthe shoulder. Hence, this suggests FUO, although no documented \nfevers here. Patient is being discharged with plan to follow up \nwith primary care in the outpatient setting.\n.\n# Shoulder Pain: Exam could be consistent with rotator cuff \ntendonitis. However, given severity of pain, patient underwent \narthrocentesis by orthopedic surgery which did not reveal e/o \ninfection. MRI of the shoulder was also conducted, which did not \nshow evidence of septic arthritis or osteomyelitis. Patient was \ndischarged with plan to follow up with primary care.\n. \n# Nausea: Patient presented with nausea. No evidence for viral \ngastroenteritis, cardiac ischemia, DKA, or diabetic \ngastroparesis. Additional history obtained indicated patient's \nnausea may have been ___ narcotic pain medicine. Her pain \nresolved after discontinuing these medicines. \n.\n# Diabetes: Type 1. On Insulin pump. ___ consulted. Continued \npump.\n.\n# HTN: continued lisinopril \n.\n# Hypothyroidism: continued levothyroxine \n.\nTRANSITIONAL ISSUES:\n- Patient admitted with fevers, chills, nausea, and general \nmalaise in context of several weeks of fevers/chills as well as \nmany months of left shoulder pain. Septic arthritis and \nosteomyelitis ruled out. Patien remained afebrile as an \ninpatient. \n- Fever of unknown origin workup should be continued as an \noutpatient. Patient requested lyme testing, given potential \nexposures in past. We have ordered this test, and this should be \nfollowed up in the outpatient setting. Patient's PCP was \ncontacted regarding this pending test.\n- Please follow up patient's final shoulder MRI read."}}
|
{'final_diagnoses': ['Rotator cuff tendonitis', 'Type 1 diabetes', 'Hypertension', 'Hypothyroidism', 'Fevers'], 'procedures': ['Arthrocentesis ___'], 'visit_summary': "# Fever/Leukocytosis: Unclear etiology; has not had fevers here \nand borderline leukocytosis has normalized raising possibility \nof stress response. Shoulder exam and XR are benign as was tap, \nsuggesting this is neither osteo nor septic arthritis assoc with \nthe shoulder. Hence, this suggests FUO, although no documented \nfevers here. Patient is being discharged with plan to follow up \nwith primary care in the outpatient setting.\n.\n# Shoulder Pain: Exam could be consistent with rotator cuff \ntendonitis. However, given severity of pain, patient underwent \narthrocentesis by orthopedic surgery which did not reveal e/o \ninfection. MRI of the shoulder was also conducted, which did not \nshow evidence of septic arthritis or osteomyelitis. Patient was \ndischarged with plan to follow up with primary care.\n. \n# Nausea: Patient presented with nausea. No evidence for viral \ngastroenteritis, cardiac ischemia, DKA, or diabetic \ngastroparesis. Additional history obtained indicated patient's \nnausea may have been ___ narcotic pain medicine. Her pain \nresolved after discontinuing these medicines. \n.\n# Diabetes: Type 1. On Insulin pump. ___ consulted. Continued \npump.\n.\n# HTN: continued lisinopril \n.\n# Hypothyroidism: continued levothyroxine \n.\nTRANSITIONAL ISSUES:\n- Patient admitted with fevers, chills, nausea, and general \nmalaise in context of several weeks of fevers/chills as well as \nmany months of left shoulder pain. Septic arthritis and \nosteomyelitis ruled out. Patien remained afebrile as an \ninpatient. \n- Fever of unknown origin workup should be continued as an \noutpatient. Patient requested lyme testing, given potential \nexposures in past. We have ordered this test, and this should be \nfollowed up in the outpatient setting. Patient's PCP was \ncontacted regarding this pending test.\n- Please follow up patient's final shoulder MRI read.", 'medications_prescribed': ['1. Cyanocobalamin 1000 mcg PO DAILY', '2. Levothyroxine Sodium 150 mcg PO DAILY', '3. Lisinopril 10 mg PO DAILY', '4. Insulin Pump SC (Self Administering Medication)Insulin \nAspart (Novolog) (non-formulary)\nBasal rate minimum: 0.5 units/hr\nBasal rate maximum: 0.9 units/hr\nBolus minimum: for breakfast 1:10 and for all other meals its \n1:15 units\nBolus maximum: for breakfast 1:10 and for all other meals its \n1:15 units\nTarget glucose: ___', 'Fingersticks: QAC and HS\nMD acknowledges patient competent\nMD has ordered ___ consult\nMD has completed competency', '5. Acetaminophen 650 mg PO Q6H:PRN pain']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 76, 'gender': 'M', 'symptoms': 'left sided weakness', 'medical_history': ['-CAD s/p 3 vessel CABG in ___ \n-HTN (treated for ___ year in the past, but apparently improved \nand\nnot currently on any meds)\n-duodenal ulcer s/p cauterization about ___ years ago (this\noccurred in the setting of being on ASA, which has seen been \nd/c)'], 'family_history': 'There is significant vascular history (CAD and\nstrokes) in his father and brothers.', 'present_illness': 'Mr. ___ is a ___ year-old right-handed man with PMH\nsignificant for CABG who presents with acute onset left sided\nweakness. His wife was present with him and noted that around 1\n___, he suddenly started sweating, slumping over and slurring his\nwords. He was immediately brought to the ___ ED within 25\nminutes of symptom onset. Prior to the onset of these symptoms,\nhe was in good health. He has no prior history of strokes. His\nvascular risk factors include CAD s/p CABG, brief history of HTN\nfor which he was on a medication (believed to be B-blocker,\nthough not currently on any meds) and about 50 pack year smoking\nhistory.', 'medications': [{'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '71', 'valuenum': 71.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '248', 'valuenum': 248.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '275', 'valuenum': 275.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'AVAILABLE AT THE ___ LAB.'}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '334', 'valuenum': 334.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '370', 'valuenum': 370.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 20.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW ASSAY IN USE ___: DETECTS D2 AND D3 25-OH ACCURATELY.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 185.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'pg/mL', 'ref_range_lower': 15.0, 'ref_range_upper': 65.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 189.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '377', 'valuenum': 377.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '388', 'valuenum': 388.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 189.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': "At admission:\nVitals: P: 77 R: 26 BP: 151/91 SaO2: 98% on 2L O2\n\nGeneral: Awake, cooperative \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx \nNeck: Supple\nPulmonary: lcta b/l \nCardiac: RRR, S1S2, no murmurs appreciated\nAbdomen: soft, NT/ND, +BS \nExtremities: warm, well perfused \n \nNeurologic: \n\n___ Stroke Scale score was: 18 \n1a. Level of Consciousness: 0 \n1b. LOC Question: 0 \n1c. LOC Commands: 0 \n2. Best gaze: 1 (right gaze preference) \n3. Visual fields: 2 \n4. Facial palsy: 2 \n5a. Motor arm, left: 4 \n5b. Motor arm, right: 0 \n6a. Motor leg, left: 4 \n6b. Motor leg, right: 0 \n7. Limb Ataxia: 0 \n8. Sensory: 2 \n9. Language: 0 \n10. Dysarthria: 1 \n11. Extinction and Neglect: 2 \n\nMental Status: Awake, alert, oriented to person, city, month and\nyear (said date was ___. He has a dense left sided neglect\n(says his hand is examiner's). Speech is dysarthric but fluent.\nHe has anomia for low frequency objects but able to name high\nfrequency objects. He is able to repeat. Comprehension is \nintact.\n\nCranial Nerves: PERRL 3 to 2mm. Left hemianopia vs. left\nhemineglect. Right gaze preference at rest. He is able to track\nfinger across midline with full EOMs. Left facial droop. \n \nMotor: Normal bulk. left UE flaccid tone and diminished tone in\nLLE. LUE plegic. LLE initially plegic but subsequently able to\nhold LLE against gravity briefly. Right sided strength is all at\nleast antigravity. \n\nSensory: No grimmace to noxious stimuli on left and says he does\nnot feel pinprick on left. he has extensor posturing with \nnoxious\nstimulation of left upper extremity and during time in ED, did\nhave withdrawal of left lower extremity to noxious. \n \nDTRs: ___ reflex slightly brisker on right compared to \nleft,\nthough brisk b/l. there was a flexor plantar response b/l. \n \nCoordination: no dysmetria on right finger-nose. Plegic on left\nso not assessed. \n \nGait: deferred \n\nPhysical Exam on Discharge:\n\n", 'diagnoses': [{'icd_code': '1623', 'desc': 'Malignant neoplasm of upper lobe, bronchus or lung'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '2639', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4928', 'desc': 'Other emphysema'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '17351', 'desc': 'Basal cell carcinoma of skin of trunk, except scrotum'}], 'summary': '___ 01:45PM BLOOD WBC-7.7 RBC-5.29 Hgb-15.7 Hct-45.7 MCV-87 \nMCH-29.8 MCHC-34.4 RDW-13.8 Plt ___\n___ 01:45PM BLOOD ___ PTT-21.5* ___\n___ 01:40PM BLOOD Creat-0.8\n___ 03:16AM BLOOD Glucose-114* UreaN-10 Creat-0.7 Na-137 \nK-4.0 Cl-107 HCO3-19* AnGap-15\n___ 03:16AM BLOOD ALT-19 AST-21 AlkPhos-62 TotBili-1.1\n___ 08:20PM BLOOD cTropnT-<0.01\n___ 03:16AM BLOOD cTropnT-<0.01\n___ 03:16AM BLOOD Albumin-3.4* Calcium-8.0* Phos-3.0 Mg-1.8 \nCholest-164\n___ 03:16AM BLOOD %HbA1c-5.7 eAG-117\n___ 03:16AM BLOOD Triglyc-80 HDL-51 CHOL/HD-3.2 LDLcalc-97\n___ 01:50PM BLOOD Glucose-98 Na-138 K-4.2 Cl-102 calHCO3-24\n___ 08:20PM URINE Color-Yellow Appear-Clear Sp ___\n___ 08:20PM URINE Blood-MOD Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-5.0 Leuks-NEG\n___ 08:20PM URINE RBC-30* WBC-<1 Bacteri-NONE Yeast-NONE \nEpi-0\n___ 08:20PM URINE bnzodzp-POS barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n\nMR head without contrast:\nIMPRESSION: Bilateral areas of restricted diffusion, more \nsignificant on the right, involving the frontal, occipital, and \ncaudate nucleus on the right and also the left frontal lobe, \nleft centrum semiovale, likely consistent with an acute/subacute \nthromboembolic ischemic event, previously demonstrated by head \nCT. \n\nNCHCT:\nIMPRESSION: Right frontal and parieto-occipital hypodensities \ncompatible with acute on subacute evolving watershed infarcts. \nNo signs of hemorrhage. Correlation with MRI is recommended. \n\nCerebral angiogram:\nFINDINGS: Left common carotid artery arteriogram shows filling \nof the left internal carotid artery along the cervical, petrous, \ncavernous, and \nsupraclinoid portion. The anterior and middle cerebral arteries \nare seen \nwell. The anterior cerebral artery is seen to be dominant on \nthe left side. There is no stenosis at the carotid bifurcation \nin the neck though there is significant calcification. \nRight common carotid artery arteriogram again shows high-grade \nstenosis of the right common carotid bifurcation at the origin \nof the external carotid. The stenosis at this segment is about \n80%. There is also distal disease involving the first 20 mm of \nthe internal carotid artery. The left middle cerebral artery \nfills well with no branch occlusion. \nRight common carotid artery arteriogram status post stenting and \nangioplasty shows widely patent right common and internal \ncarotid artery. There is no residual stenosis. Right common \nfemoral artery arteriogram shows widely patent right common \nfemoral artery. \nIMPRESSION: ___ underwent carotid stenting and \nangioplasty after he presented with a high-grade stenosis and a \nright hemispheric syndrome. There were no complications. \n\nCTA head and neck:\nIMPRESSION: \n1. Evidence of extensive acute ischemia throughout the right \nmiddle cerebral arterial territory, with focal abnormalities of \nrCBV/CBF, within, as well as in the contralateral hemisphere, \nsuspicious for "core" infarcts. \n2. Extensive steno-occlusive disease involving the right \ninternal carotid \nartery from its origin and throughout its cervical portion. \nThere is only \nminimal evidence of recanalization, with flow to the carotid \nterminus and \nipsilateral MCA via cross-filling from a patent circle of \n___. as detailed above. \n3. Markedly anomalous posterior circulation, as detailed above, \nincluding a very large-caliber and tortuous left persistent \ntrigeminal artery (a patent fetal carotico-basilar anastomosis), \nas well as a robust fetal-type right PCA. This likely accounts \nfor the markedly small caliber of the distal V4 segments of both \nvertebral arteries, which demonstrate effective \n___, as well as the very diminutive basilar artery. \n\n4. No evidence of significant steno-occlusive disease or \naneurysm larger than 2 mm involving the intracranial \ncirculation. \n5. Severe bullous pan-acinar emphysema involving the included \nlung apices. \n\nCXR:\nIMPRESSION: \nAn endotracheal tube is seen with its tip approximately 5 to 5.5 \ncm above the carina. A nasogastric tube is seen coursing below \nthe diaphragm with its tip within the stomach. The patient is \nstatus post median sternotomy. Heart is upper limits of normal \nin size. The mediastinal contours are within normal limits. \nCalcification of the aorta is consistent with sclerosis. There \nis some perihilar fullness and vascular redistribution \nsuggestive of pulmonary venous hypertension, no overt pulmonary \nedema. No focal airspace consolidation is seen to suggest \npneumonia. No pleural effusions or pneumothoraces \n\nTransthoracic Echo:\n Mild pulmonary artery systolic hypertension. Normal \nbiventricular cavity sizes with preserved global and regional \nbiventricular systolic function. No definite structural cardiac \nsource of embolism identified.\n\nTransesophageal Echo:\nNo PFO, ASD or intracardiac thrombus. Complex artheroma in the \ndescending aorta. Normal biventricular size and global systolic \nfunction. \n\nLabs on Discharge:\nnone\n\nMr. ___ is a ___ year-old right-handed man with PMH significant \nfor CAD s/p CABG (in ___ who presents with left sided \nweakness.\n\nNEURO: He was a CODE STROKE, with deficits notable for right \ngaze preference, left neglect, left facial droop and initially \nleft sided plegia and sensory loss; initial NIHSS 18. On \nimaging, he was found to have an acute R MCA stroke and found to \nhave right ICA occlusion with distal recanalization, but then \nalso with apparent R superior divivision MCA occlusion. He \nreceived IV tpA- bolus at 1350 (symptom onset at 1300). There \nwere no clear initial improvement in deficits aside from some \nimprovement in movement of left lower extremity and pupils more \nin midline at rest. Given lack of significant improvement and \nclot noted on CTA, he was sent for interventional angiogram. A \nstent was placed in the right proximal ICA for high-grade \nstenosis with good perfusion afterwards. MRI post intervention \nshowed infarcts involving the frontal, occipital, and caudate \nnucleus on the right and the left frontal lobe and left centrum \nsemiovale. The patient was seen by physical and occupational \ntherapy and his strength gradually improved in his left leg, \nthough not left arm, over the ensuing days. The right MCA and \nPCA infarcts are most probably due to emboli/hypoperfusion from \nthe right ICA occlusion (the right PCA infarct can be explained \nby emboli through the right fetal PCA to the occipital lobe). \nThe small left frontal and left centrum semiovale infarcts are \npossibly due to emboli that were generated by the catheter \nduring the conventional angiogram procedure. Despite extensive \nevaluation, no cardioembolic source was found. The patient was \nrecommended to undergo Holter monitoring as an outpatient to \nevaluate again for possible atrial fibrillation. \n\nCARDIAC: The patient was monitored on telemetry with no signs of \natrial fibrillation. TTE revealed no intracardiac thrombus and \nno PFO. TEE showed complex atheroma in the descending aorta. \nClopidogrel 75mg po daily started for secondary stroke \nprevention and to prevent stent rethrombosis. Simvastatin 20mg \npo daily was started for goal LDL < 100.\n\nDIET: after being seen by speech and swallow the patient had \npureed solids and thin liquids.\n\nPatient was Full Code\n\n1. Dysphagia screening before any PO intake? y\n2. DVT Prophylaxis administered? Y\n3. Antithrombotic therapy administered by end of hospital day 2? \nY\n4. LDL documented? Y LDL 97\n5. Intensive statin therapy administered? No, LDL <100\n6. Smoking cessation counseling given? Y\n7. Stroke education given? Y\n8. Assessment for rehabilitation? Y\n9. Discharged on statin therapy? Y\n10. Discharged on antithrombotic therapy? Y Plavix\n11. Discharged on oral anticoagulation for patients with atrial \nfibrillation/flutter? N/A\n\nPENDING RESULTS\nPlatelet Aggregation Assay'}}
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{'final_diagnoses': ['Right ischemic stroke with Right ICA occlusion'], 'procedures': ['cerebral angiogram with intervention'], 'visit_summary': 'Mr. ___ is a ___ year-old right-handed man with PMH significant \nfor CAD s/p CABG (in ___ who presents with left sided \nweakness.\n\nNEURO: He was a CODE STROKE, with deficits notable for right \ngaze preference, left neglect, left facial droop and initially \nleft sided plegia and sensory loss; initial NIHSS 18. On \nimaging, he was found to have an acute R MCA stroke and found to \nhave right ICA occlusion with distal recanalization, but then \nalso with apparent R superior divivision MCA occlusion. He \nreceived IV tpA- bolus at 1350 (symptom onset at 1300). There \nwere no clear initial improvement in deficits aside from some \nimprovement in movement of left lower extremity and pupils more \nin midline at rest. Given lack of significant improvement and \nclot noted on CTA, he was sent for interventional angiogram. A \nstent was placed in the right proximal ICA for high-grade \nstenosis with good perfusion afterwards. MRI post intervention \nshowed infarcts involving the frontal, occipital, and caudate \nnucleus on the right and the left frontal lobe and left centrum \nsemiovale. The patient was seen by physical and occupational \ntherapy and his strength gradually improved in his left leg, \nthough not left arm, over the ensuing days. The right MCA and \nPCA infarcts are most probably due to emboli/hypoperfusion from \nthe right ICA occlusion (the right PCA infarct can be explained \nby emboli through the right fetal PCA to the occipital lobe). \nThe small left frontal and left centrum semiovale infarcts are \npossibly due to emboli that were generated by the catheter \nduring the conventional angiogram procedure. Despite extensive \nevaluation, no cardioembolic source was found. The patient was \nrecommended to undergo Holter monitoring as an outpatient to \nevaluate again for possible atrial fibrillation. \n\nCARDIAC: The patient was monitored on telemetry with no signs of \natrial fibrillation. TTE revealed no intracardiac thrombus and \nno PFO. TEE showed complex atheroma in the descending aorta. \nClopidogrel 75mg po daily started for secondary stroke \nprevention and to prevent stent rethrombosis. Simvastatin 20mg \npo daily was started for goal LDL < 100.\n\nDIET: after being seen by speech and swallow the patient had \npureed solids and thin liquids.\n\nPatient was Full Code\n\n1. Dysphagia screening before any PO intake? y\n2. DVT Prophylaxis administered? Y\n3. Antithrombotic therapy administered by end of hospital day 2? \nY\n4. LDL documented? Y LDL 97\n5. Intensive statin therapy administered? No, LDL <100\n6. Smoking cessation counseling given? Y\n7. Stroke education given? Y\n8. Assessment for rehabilitation? Y\n9. Discharged on statin therapy? Y\n10. Discharged on antithrombotic therapy? Y Plavix\n11. Discharged on oral anticoagulation for patients with atrial \nfibrillation/flutter? N/A\n\nPENDING RESULTS\nPlatelet Aggregation Assay', 'medications_prescribed': ['1. Clopidogrel 75 mg PO DAILY \nPlease start morning of ___ \nRX *clopidogrel 75 mg 1 Tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*2', '2. Lisinopril 10 mg PO DAILY \nRX *lisinopril 10 mg 1 Tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*0', '3. Simvastatin 20 mg PO DAILY \nRX *simvastatin 20 mg 1 Tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'SOB, chest heaviness x several hours', 'medical_history': ['<i>Cardiac Risk Factors:</i> (+)Diabetes, (+)Dyslipidemia, \n(-)Hypertension, (-) current smoker, (-) FH/o early MI', 'CAD ? h/o MI ?', 'CHF, EF 50% ___', 'AF, s/p Pacemaker on Coumadin', '<i>Coronary Artery Bypass Grafts:</i> none', '<i>Percutaneous Coronary Interventions:</i>\n-Clean cath circa ___ per OSH records (apparently at ___, but \nno record in OMR0', '<i>Pacing / ICD:</i> Single lead pacer', '<B><U>OTHER PAST MEDICAL HISTORY:</B></U>\nBenign polyp\nOA\nBPH\nDepression'], 'family_history': 'Father with MI in his ___. Otherwise no family history of \narrhythmia, cardiomyopathies, or sudden cardiac death; otherwise \nnon-contributory.', 'present_illness': '___ yo WWII ___ corps veteran, with AF s/p pacemaker on \nwarfarin, CHF (EF 50), CAD, COPD with asbestosis on 2L home O2 \nfor 6 months, who presents with SOB and chest pressure for \nseveral hours (TIMI=2)in the setting of baseline exertional \ndyspnea and fatigue on exertion, with recent hospitalizations \nfor recurrent transudative R > L pleural effusions and pneumonia \ntreated with Zosyn (historically treated with Cetriaxone and \nAzithromycin).\n.\nNight before admission had chest pressure and SOB with exertion. \nPrior to this episode, he had been at home for about a week \nafter discharging himself electively from a rehab because he was \nunsatisfied with the care he was receiving; nevertheless, his \nrehab course was essentially stable - noting no change in his \nexertional dyspnea.\n.\nHe was discharged to rehab from ___ after being \nhospitalized in ___ for the same presenting complaint as \nthis hospitalization - dyspnea and non-specific atypical chest \nheaviness. He was found to have a recurrent R pleural effusion, \nloculated on CT, and a smaller layering L pleural effusion; he \nwas also treated for a RUL PNA with Zosyn. He was hospitalized \nin ___ for the same presenting complaint and found to have \npleural effusion in the setting of PNA. The OSH work-up, \nspanning 2 hospitalizations, involved thoracentesis 3 times in \n___ and a ___ time in ___ - found to be transudative, \npotentially parapneumonic and CHF related, but not exudative, no \nmalignancy, and no empyema on any of the taps.\n.\nAccording to the OSH records, he was discharged in good \ncondition, with SOB improved.\n.\nHe notes that he has been adherent to his medications and a low \nsodium diet.\n.\nIn the ED, initial VS were: 96.6 84 109/60 28 100% 10L NRB. \nPatient was given 40 IV Lasix and put out 1L after a foley was \nplaced; nebs were also given.\n.\n.\n<U><B>CARDIAC REVIEW OF SYSTEMS:</B></U>\n(+) Per HPI\n(-) Denies chest pain, orthopnea, palpitations, syncope or \npresyncope.\n.\n<U><B>OTHER REVIEW OF SYSTEMS:</B></U>\n(+) Per HPI \n(-) Denies any exertional buttock or calf pain; prior history of \nstroke, TIA, deep venous thrombosis, pulmonary embolism; \nbleeding at the time of surgery, hemoptysis, black or red \nstools.\n.\nAlso denies fevers, chills, myalgias, joint pains; cough, \nwheezes; diarrhea, or recent change in bowel habits; dysuria or \nchange in voiding habits; rashes or skin breakdown; \nnumbness/tingling in extremities; feelings of depression or \nanxiety. All of the other review of systems were negative.', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aliskiren', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'ABN COLOR MAY AFFECT DIPSTICK.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission PE:\nGENERAL: WDWN in NAD. Alert & Oriented x3. Mood, affect \nappropriate. No central or peripheral cyanosis; no jaundice, no \npalor.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI.\nNECK: Supple; no JVD.\nCARDIAC: PMI non-displaced. RR, normal S1, S2; no S3, S4. No \nm/r/g. No thrills, lifts.\nLUNGS: CTAB, apical right sided wheezes. Decreased basilar \nbreath sounds bilaterally. Respirations unlabored, no accessory \nmuscle use.\nABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.\nGROIN: No femoral bruits.\nEXTREMITIES: ___ edema, Right > Left \nSKIN: No stasis dermatitis, ulcers, scars. \nPULSES:\nRight: not palpable\nLeft: not palpable\nNEURO: CN2-12 intact; moving 4 extremities spontaneously\n.\nDischarge PE:\nUnchanged other than,\n**LUNGS: Improved basilar breath sounds; wet crackles present. \nNo wheezes throughout. Respirations unlabored, no accessory \nmuscle use.', 'diagnoses': [{'icd_code': '5761', 'desc': 'Cholangitis'}, {'icd_code': '57451', 'desc': 'Calculus of bile duct without mention of cholecystitis, with obstruction'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}], 'summary': "Admission Labs:\n\n___ 11:00PM PTT-81.4*\n___ 06:55PM CK-MB-3 cTropnT-0.02*\n___ 06:55PM ___ PTT-53.0* ___\n___ 03:30PM GLUCOSE-68* UREA N-29* CREAT-1.2 SODIUM-142 \nPOTASSIUM-4.4 CHLORIDE-99 TOTAL CO2-35* ANION GAP-12\n___ 03:30PM GLUCOSE-70 UREA N-29* CREAT-1.2 SODIUM-143 \nPOTASSIUM-4.4 CHLORIDE-99 TOTAL CO2-36* ANION GAP-12\n___:30PM CK-MB-3 cTropnT-0.01\n___ 03:30PM CALCIUM-9.3 PHOSPHATE-3.6 MAGNESIUM-2.1\n___ 03:30PM CALCIUM-9.5 PHOSPHATE-3.6 MAGNESIUM-2.1\n___ 03:30PM WBC-5.6 RBC-3.76* HGB-10.2* HCT-32.3* MCV-86 \nMCH-27.2 MCHC-31.7 RDW-17.7*\n___ 03:30PM PLT COUNT-143*\n___ 11:10AM GLUCOSE-151* UREA N-29* CREAT-1.2 SODIUM-142 \nPOTASSIUM-4.4 CHLORIDE-100 TOTAL CO2-36* ANION GAP-10\n___ 11:10AM ALT(SGPT)-10 AST(SGOT)-13 LD(LDH)-142 \nCK(CPK)-37* ALK PHOS-62 TOT BILI-0.6\n___ 11:10AM CK-MB-4 cTropnT-0.01\n___ 11:10AM ALBUMIN-3.6 CALCIUM-9.4 PHOSPHATE-3.3 \nMAGNESIUM-2.0 IRON-47 CHOLEST-133\n___ 11:10AM calTIBC-282 VIT B12-281 FERRITIN-250 TRF-217\n___ 11:10AM TRIGLYCER-89 HDL CHOL-50 CHOL/HDL-2.7 \nLDL(CALC)-65\n___ 11:10AM TSH-2.0\n___ 01:54AM GLUCOSE-100 UREA N-33* CREAT-1.2 SODIUM-141 \nPOTASSIUM-4.8 CHLORIDE-99 TOTAL CO2-34* ANION GAP-13\n___ 01:54AM estGFR-Using this\n___ 01:54AM CK(CPK)-39*\n___ 01:54AM cTropnT-<0.01\n___ 01:54AM CK-MB-3 proBNP-2089*\n___ 01:54AM WBC-6.7 RBC-3.71* HGB-10.4* HCT-31.7* MCV-86 \nMCH-28.0 MCHC-32.7 RDW-17.7*\n___ 01:54AM NEUTS-76.4* LYMPHS-15.4* MONOS-5.6 EOS-2.4 \nBASOS-0.2\n___ 01:54AM PLT COUNT-141*\n___ 01:54AM ___ PTT-35.8* ___\n___ 01:54AM RET AUT-3.3*\n.\nOSH Studies:\nCT OSH: ___:\n-Mod RUL infiltrate new from CT ___ consistent with PNA\n-persistent small p.effusions and bibas atelect\n-dense pleural calcific bilat c/w prior asbestosis\n.\nCT: ___:\n-dense calficic plaques consistent with asbestos exposure \nunchanged\n-bilat p.effusions R loculated posterolaterally, left deceased\n-focal parench consolid R and L lower lobes\n-RUL unchanged\n.\nCT OSH ___:\n-Bilat p.effusions , mild CHF\n-pleural calcifications\n.\nBilateral LENIs ___\n-NO DVT\n.\nCXR ___\n-Possible RUL infiltrate improved from previous 4 days earlier, \npartly obscure by Pacemaker\n-Pleural effusions R>L with some R loculations\n-Compressive R base atelectasis\n-Lungs grossly clear, no PTX\n.\nCXR ___:\n-Loculated non layering mod size R p.effusion\n-small layering left p.effusion unchanged from ___\n.\n___ OSH:\n-Normal LV size\n-EF 50%\n-Concentric LVH\n-Biatrial enlargement\n-Mild pulmonary HTN\n-Mild TI\n.\n___ OSH:\n-EF 45-50%\n-Mod LVH\n-Mod ___\n-Mod Pulm HTN\n-Mild TI\n.\n___ Studies:\n.\nEKG:\nAdmission ___:\nProbable atrial fibrillation with ventricular premature beats, \nventricular pacing and intermittent intrinsically conducted \nbeats. The QTc interval appears prolonged but is difficult to \nmeasure. Since the previous tracing of same date ventricular \nectopy is now present.\n.\n___:\nProbable atrial fibrillation with ventricular paced rhythm and \nintermittently intrinsically conducted beats. Since the previous \ntracing of ___ there is probably no significant change.\n.\n___:\nVentricular paced rhythm with underlying rhythm probably atrial \nfibrillation. Compared to the previous tracing of ___ there \nis no change. \n \n\n.\nCath:\n.\n1. Selective coronary angiography in this right dominant sytem \ndemonstrated non-obstructive coronary artery disease. The LMCA \nhad a 20% stenosis. The LAD had a 50% stenosis at the origin. \nThe LCx and RCA had mild, diffuse disease. \n2. Resting hemodynamics revealed elevated and near equalization \nof filling pressures with RVEDP 20mmHg and LVEDP 15 mmHg. There \nwas moderate pulmonary arterial systolic hypertension wiht PASP \n52 mmHg. The cardiac index was preserved at 3.1 L/min/m2. There \nwas systemic arterial systolic hypotension 78.38 mmHg. \n3. There was no evidence of aortic stenosis on careful pullback \nof the catheter from the left ventricle to the ascending aorta. \n. \nFINAL DIAGNOSIS: \n1. Coronary arteries with mild disease. \n2. Elevated filling pressures with near equalization suggestive \nof constriction/restriction. \n3. Moderate pulmonary hypertension. \n.\n\nTTE:\n___:\nThe left ventricular cavity size is normal. There is a \ntrivial/physiologic pericardial effusion. There is an anterior \nspace which most likely represents a prominent fat pad. \n\nCompared with the prior study (images reviewed) of ___, \npericardial appearance is similar. \n.\nCXR:\nAdmission ___\nIMPRESSION: \n1. New bilateral moderately large pleural effusions. \n \n2. New right upper lobe opacity, relates in part to pleural \nfluid and probable edema but is not completely evaluated on this \nradiograph, a repeat erect PA and lateral chest radiograph is \nrecommended after adequate diuresis. \n.\n___\nCOMPARISON: CXR ___. \n \nFINDINGS: Since the prior radiograph, there has been drainage of \nthe right \npleural effusion with replacement by a loculation of air in the \nright \ncostophrenic angle. The left pleural effusion and associated \natelectasis are stable. The cardiac and mediastinal silhouettes \nare stable without evidence of tension. A pacemaker is in place \nwith the lead in the right atrium. The right pleural catheter \nprojects over the right lateral costophrenic sulcus. \nIMPRESSION: Small pneumothorax in the right costophrenic sulcus \nwithout \ntension. \n\n.\n___ ___ L & R)\nFINDINGS: In comparison with the study of ___, there is little \noverall \nchange. The loculated small pneumothorax in the region of the \nright \ncostophrenic angle is again seen. Mild pulmonary vascular \ncongestion \npersists. Bilateral pleural effusions, more prominent on the \nleft, are again seen. \n.\n___ Lat/Decub:\nCOMPARISON: CXR ___. \n \nFINDINGS: Since the prior study, there has been small \nreaccumulation of the right pleural effusion with partial \nloculation. A tiny loculated right \npneumothorax is also seen. A small left pleural effusion is \nstable in size and is also partly loculated. A small left \nloculated pneumothorax is seen in the lateral decubitus view. \nBibasilar atelectasis is largely unchanged. The cardiac and \nmediastinal silhouettes are stable. \nIMPRESSION: Small bilateral partially loculated pleural \neffusions and small loculated pneumothoraces.\n.\nCOMPARISON: CXR ___. \n \nFINDINGS: Since the prior study, there has been small \nreaccumulation of the right pleural effusion with partial \nloculation. A tiny loculated right \npneumothorax is also seen. A small left pleural effusion is \nstable in size \nand is also partly loculated. A small left loculated \npneumothorax is seen on the lateral decubitus view. Bibasilar \natelectasis is largely unchanged. The cardiac and mediastinal \nsilhouettes are stable. \n \nIMPRESSION: Small bilateral partially loculated pleural \neffusions and small loculated pneumothoraces. \n.\nPleural fluid:\nMesothelial cells and abundant mature lymphocytes. \n \nNote: Recommend re-submission of pleural fluid for cytologic \nstudy if effusion re-accumulate. \n.\n.\nDischarge Labs:\n___ yo WWII ___ corps veteran, with AF s/p pacemaker on \nwarfarin, CHF (EF 50), CAD, COPD with asbestosis on 2L home O2 \nfor 6 months, who presents with SOB and chest pressure for \nseveral hours (TIMI=2) in the setting of baseline exertional \ndyspnea and fatigue on exertion, with recent hospitalizations \nfor recurrent transudative R > L pleural effusions and pneumonia \ntreated with Zosyn (previously treated with Cetriaxone and \nAzithromycin) presented with unstable angina, had a clean cath \nwith equalization of R/L filling pressures, and underwent \nbilateral therapeutic thoracenteses showing transudative \neffusions and evidence of empyema or malignancy, and was also \ndiagnosed with central/obstructive sleep apnea and started on \nCPAP.\n.\nACTIVE ISSUES:\n.\n# Unstable Angina: Presented with angina concerning for ACS; \nenzymes were negative and there were no ischemic EKG changes; \ncath showed no clinically significant coronary disease. He was \ndischarged on ASA 325, Simvastatin 40, Atenolol 25, Lisinopril \n2.5, and SL Nitro prn CP.\n.\n# Nocturnal hypoxia: Transiently desatted into the ___ early in \nthe hospitalization, with sats returning to the high ___ on \n___ mask or nasal canula with superimposed face mask. \nSleep medicine was consulted, who diagnosed obstructive and \ncentral sleep apnea, recommending CPAP and outpatien follow-up \nwith the sleep clinic. **The patient's face mask does not fit \nproperly and he will need a custom-fit facemask to ensure \nadherence withthe CPAP.**\n.\n# P.Effusions: OSH records showed this to be a recurrent \nproblem, with 3 thoracenteses prior to this admission, all of \nwhich showed transudative effusion with no evidence of \nmalignancy or empyema. The patient was intitially diuresed early \nin this hospitalization as detailed below for suspected \ndecompensated heart failure, but CXR and symptoms did not \nsignificantly improve. Pulmonary and Interventional Pulmonary \nwere consulted; bilateral thoracenteses were performed, R \ndraining about 1L of blood transudative fluid and L draining \nabout 2 L. The drains were pulled 1 day after the procedures. \nThe patient's symptoms improved after the thoracenteses, with \nhim noting decreased SOB and fatigue; however, CXR prior to \ndischarge showed no significant interval improvement. At the \ntime of discharge, the pulmonary team's plan is to have the \npatient follow-up ___ to reassess placement of a pleurex \ncatheter on the left side and potentially perform another \nthoracentesis on the right to be followed by a pleurex catheter \nat a later date. **Once a decision is reached regarding \ndefinitive treatment of the patient's recurrent effusions, his \ncoumadin will need to be stopped, then restarted after the \nprocedure.** Of note, the pulmonary team deamed the patient's \npleural calcifications to be of little clinical significance and \npleural fluid analysis showed no evidence of malignancy or \nempyema; the etiology is likely decompensated heart failure.\n.\n# AF CHADS2=2: Remained hemodynamically stable V-paced with \nintermittent native conduction and occasional ectopy. Discharged \non coumadin with a therapeutic INR. **Cessation of coumadin for \npleurex catheter placement will need to be discussed at upcoming \noutpatient pulmonary follow-up.**\n.\n# Decompensated dCHF: Initial presentation was concerning for \ndecompensated dCHF, however this was prior to obtaining OSH \nrecords, including the patient's previous ECHOs that showed mild \ndiastolic dysfunction and a preserved EF, as well as the \npatient's previous hospitalizations for recurrent pulmonary \neffusions. Was initially aggressively diuresed, causing ___ and \nhypotension as below, but then diuresis was stopped and the \npatient was maintained in euvolemic condition on his home \ndiuretic regimen of lasix and spironolactone unchanged. \nDischarge weight was 110 kg from 114 kg.\n.\n# Equalization of R & L filling pressures: Cath showed \nequalization of filling pressures suggestive of constrictive \nphysiology in the setting of known asbestosis - L/R ___. Given \nthe patient's symptomatic improvement with the above \ninterventions, further testing was deferred. **Whether to \nperform an outpatient MRI and to further evaluate for further \nsurgical intervention, will need to be revisited after discharge \n- albeit this may raise a number of pros/cons that will need \nfurther discussion with the family.**\n.\n# Hypovolemic hypotension: Developed fluid-responsive \nhypotension after being over diuresed; this was also in the \nsetting of being very somnolent after a sleepless night midway \nthrough the hospitalization. After fluid resuscitation, SBPs \nwere stabily ranging high ___ to low 100s.\n.\n# ___: Developed pre-renal ___ as a result of overdiuresis, \nwhich resolved with cessation of IV lasix.\n.\n# Hematuria: Developed hematuria on Hep Gtt, ASA, and \ntherapeutic INR early in the hospitalization; hematuria resolved \nwith discontinuation of heparin.\n.\n# Anemia: Presented with an anemia and Hct remained stable \nbetween 28 and 32 in the settin of the above hematuria; it was \nabout 30 3 days prior to discharge. Work-up revealed a mixed \npicture of ACD, iron deficiency, and borderline low B12; \ndischarged on iron supplementation, B12, and multivitamin. \n**Work-up for iron deficiency and follow-up HCT will need to be \nchecked after discharge.**\n.\nINACTIVE/CHRONIC ISSUES:\n.\n# GERD: Contined home regimen of Protonix 40 daily.\n.\n# COPD: Continued ___ home regimen of Singulaire 10 daily and \nIpratrop Nebs as needed.\n.\nTRANSITIONAL ISSUES:\nAs above in **."}}
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{'final_diagnoses': ['PRIMARY:', '-Left pleural effusion', '-Right pleural effusion', '-Obstructive sleep apnea', '-Central sleep apnea', '-Chronic diastolic heart failure', 'SECONDARY:', '-Atrial fibrillation with pacemaker in place'], 'procedures': ['-Cardiac catheterization without intervention', '-Right thoracentesis (draining of fluid from around the lungs)', '-Left thoracentesis (draining of fluid from around the lungs)'], 'visit_summary': "___ yo WWII ___ corps veteran, with AF s/p pacemaker on \nwarfarin, CHF (EF 50), CAD, COPD with asbestosis on 2L home O2 \nfor 6 months, who presents with SOB and chest pressure for \nseveral hours (TIMI=2) in the setting of baseline exertional \ndyspnea and fatigue on exertion, with recent hospitalizations \nfor recurrent transudative R > L pleural effusions and pneumonia \ntreated with Zosyn (previously treated with Cetriaxone and \nAzithromycin) presented with unstable angina, had a clean cath \nwith equalization of R/L filling pressures, and underwent \nbilateral therapeutic thoracenteses showing transudative \neffusions and evidence of empyema or malignancy, and was also \ndiagnosed with central/obstructive sleep apnea and started on \nCPAP.\n.\nACTIVE ISSUES:\n.\n# Unstable Angina: Presented with angina concerning for ACS; \nenzymes were negative and there were no ischemic EKG changes; \ncath showed no clinically significant coronary disease. He was \ndischarged on ASA 325, Simvastatin 40, Atenolol 25, Lisinopril \n2.5, and SL Nitro prn CP.\n.\n# Nocturnal hypoxia: Transiently desatted into the ___ early in \nthe hospitalization, with sats returning to the high ___ on \n___ mask or nasal canula with superimposed face mask. \nSleep medicine was consulted, who diagnosed obstructive and \ncentral sleep apnea, recommending CPAP and outpatien follow-up \nwith the sleep clinic. **The patient's face mask does not fit \nproperly and he will need a custom-fit facemask to ensure \nadherence withthe CPAP.**\n.\n# P.Effusions: OSH records showed this to be a recurrent \nproblem, with 3 thoracenteses prior to this admission, all of \nwhich showed transudative effusion with no evidence of \nmalignancy or empyema. The patient was intitially diuresed early \nin this hospitalization as detailed below for suspected \ndecompensated heart failure, but CXR and symptoms did not \nsignificantly improve. Pulmonary and Interventional Pulmonary \nwere consulted; bilateral thoracenteses were performed, R \ndraining about 1L of blood transudative fluid and L draining \nabout 2 L. The drains were pulled 1 day after the procedures. \nThe patient's symptoms improved after the thoracenteses, with \nhim noting decreased SOB and fatigue; however, CXR prior to \ndischarge showed no significant interval improvement. At the \ntime of discharge, the pulmonary team's plan is to have the \npatient follow-up ___ to reassess placement of a pleurex \ncatheter on the left side and potentially perform another \nthoracentesis on the right to be followed by a pleurex catheter \nat a later date. **Once a decision is reached regarding \ndefinitive treatment of the patient's recurrent effusions, his \ncoumadin will need to be stopped, then restarted after the \nprocedure.** Of note, the pulmonary team deamed the patient's \npleural calcifications to be of little clinical significance and \npleural fluid analysis showed no evidence of malignancy or \nempyema; the etiology is likely decompensated heart failure.\n.\n# AF CHADS2=2: Remained hemodynamically stable V-paced with \nintermittent native conduction and occasional ectopy. Discharged \non coumadin with a therapeutic INR. **Cessation of coumadin for \npleurex catheter placement will need to be discussed at upcoming \noutpatient pulmonary follow-up.**\n.\n# Decompensated dCHF: Initial presentation was concerning for \ndecompensated dCHF, however this was prior to obtaining OSH \nrecords, including the patient's previous ECHOs that showed mild \ndiastolic dysfunction and a preserved EF, as well as the \npatient's previous hospitalizations for recurrent pulmonary \neffusions. Was initially aggressively diuresed, causing ___ and \nhypotension as below, but then diuresis was stopped and the \npatient was maintained in euvolemic condition on his home \ndiuretic regimen of lasix and spironolactone unchanged. \nDischarge weight was 110 kg from 114 kg.\n.\n# Equalization of R & L filling pressures: Cath showed \nequalization of filling pressures suggestive of constrictive \nphysiology in the setting of known asbestosis - L/R ___. Given \nthe patient's symptomatic improvement with the above \ninterventions, further testing was deferred. **Whether to \nperform an outpatient MRI and to further evaluate for further \nsurgical intervention, will need to be revisited after discharge \n- albeit this may raise a number of pros/cons that will need \nfurther discussion with the family.**\n.\n# Hypovolemic hypotension: Developed fluid-responsive \nhypotension after being over diuresed; this was also in the \nsetting of being very somnolent after a sleepless night midway \nthrough the hospitalization. After fluid resuscitation, SBPs \nwere stabily ranging high ___ to low 100s.\n.\n# ___: Developed pre-renal ___ as a result of overdiuresis, \nwhich resolved with cessation of IV lasix.\n.\n# Hematuria: Developed hematuria on Hep Gtt, ASA, and \ntherapeutic INR early in the hospitalization; hematuria resolved \nwith discontinuation of heparin.\n.\n# Anemia: Presented with an anemia and Hct remained stable \nbetween 28 and 32 in the settin of the above hematuria; it was \nabout 30 3 days prior to discharge. Work-up revealed a mixed \npicture of ACD, iron deficiency, and borderline low B12; \ndischarged on iron supplementation, B12, and multivitamin. \n**Work-up for iron deficiency and follow-up HCT will need to be \nchecked after discharge.**\n.\nINACTIVE/CHRONIC ISSUES:\n.\n# GERD: Contined home regimen of Protonix 40 daily.\n.\n# COPD: Continued ___ home regimen of Singulaire 10 daily and \nIpratrop Nebs as needed.\n.\nTRANSITIONAL ISSUES:\nAs above in **.", 'medications_prescribed': ['1. CPAP', '2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '3. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). ', '4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. ', '5. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '6. spironolactone 25 mg Tablet Sig: One (1) Tablet PO EVERY \nOTHER DAY (Every Other Day). ', '7. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '8. warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___.Disp:*30 Tablet(s)* Refills:*2*', '9. Mucinex ___ mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO twice a day. ', '10. Ocean Nasal Mist 0.65 % Aerosol, Spray Sig: One (1) Spray \nNasal twice a day: In each nostril. ', '11. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '12. DuoNeb 0.5 mg-3 mg(2.5 mg base)/3 mL Solution for \nNebulization Sig: One (1) nebulizer treatment Inhalation four \ntimes a day as needed for shortness of breath or wheezing. ', '13. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 \ntimes a day) as needed for Pain. ', '15. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, \nSublingual Sublingual PRN (as needed) as needed for CP.\nDisp:*10 Tablet, Sublingual(s)* Refills:*0*', '16. multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '17. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for constipation.\nDisp:*30 Tablet(s)* Refills:*2*', '18. Iron (ferrous sulfate) 325 mg (65 mg Iron) Tablet Sig: One \n(1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '19. cyanocobalamin (vitamin B-12) 1,000 mcg Tablet Sig: One (1) \nTablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '20. Outpatient Lab Work\n___:\n# Check INR - fax results to rehab physician, who may adjust \nwarfarin according to the INR\n# Check CBC - fax results to rehab physician; last CBC on \n___ was stable at ___\n# Check Electrolytes - fax results to rehab physician, who may \nreplete electrolytes; patient is on a longstanding regimen of \nlasix and spironolactone']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 19, 'gender': 'M', 'symptoms': 'lightheadedness', 'medical_history': ['Testicular cancer with retroperitoneal metastasis, status\npost tumor resection and chemotherapy in ___.', 'Status post cholecystectomy.', 'Prostate cancer status post prostatectomy.', 'Recurrent SBOs, x 5.', 'Atrial fibrillation, diagnosed approximately ___ years ago.'], 'family_history': 'Thinks father had atrial fibrillation. No family history of \nearly MI, cardiomyopathies, or sudden cardiac death; otherwise \nnon-contributory.', 'present_illness': 'Mr. ___ is a ___ old man with history of metastatic \ntesticular cancer s/p chemotherapy and resection, prostate \ncancer s/p prostatectomy, recurrent SBO, and atrial fibrillation \nand heart failure with reduced ejection fraction likely \ntachycardia-mediated who presents with lightheadedness. \n\nHe was initially diagnosed with atrial fibrillation in the \nsetting of SBO ___ years ago but has since remained asymptomatic. \nHowever, over the past month he has noted progressive fatigue, \ndyspnea on exertion, and orthopnea. On ___, he \npresented to ___ where he was found to be in atrial \nfibrillation. He was admitted and TTE revealed a LVEF of 20%, \nsevere mitral regurgitation, and moderate tricuspid \nregurgitation. Medical therapy was initiated with carvedilol, \ncaptopril, and furosemide as well as rivaroxaban for \nthromboembolic prophylaxis. He was discharged on the ___ and \nthen saw Dr. ___ in clinic on the ___ at which time he was \nstable from a cardiovasucular standpoint. \n\nHis ventricular rate was controlled and he was euvolemic. He was \nstarted on a PO amiodarone load with a plan for ___ on ___ and he was continued on his other medications. This morning \nhe felt lightheaded as he got up from bed. He notes associated \nnausea but denies chest pain, dyspnea, palpitations, or syncope. \nHis symptoms persisted so he came to the ___ ED. There, he \nagain felt lightheaded when going from lying down to sitting up. \nThe lightheadedness resolved after drinking some water. Of note, \nthe patient has been on furosemide 20 mg daily and he has been \nadherent to a 2L per day fluid restriction. He notes that he did \nnot drink much water at all yesterday. \n\nIn the ED, initial vitals were: T 97.2, HR 80, BP 148/105, RR \n16, SaO2 100% RA. He was seen by cardiology, who felt that he \nmay need further diuresis, given the vascular congestion seen on \nCXR, but that his diuresis to this point may have been too \nrapid, given the positional lightheadedness and also the \ncreatinine bump (creatinine 1.6 on admission, up from 1.1 three \nwks ago on ___ at ___. \n\nOn review of systems, he denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, bleeding at the \ntime of surgery, myalgias, joint pains, cough, hemoptysis, black \nstools or red stools. He denies recent fevers, chills or rigors. \nHe denies exertional buttock or calf pain. All of the other \nreview of systems were negative. \n\nCardiac review of systems is notable for absence of chest pain, \nparoxysmal nocturnal dyspnea, orthopnea, ankle edema, \npalpitations, syncope.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'Admission physical exam:\nVS: Wt= T=98.5 BP=137/84 HR=72 RR=18 O2 sat=97 RA \nOrthostatics: 128/89 lying, 131/86 sitting, 134/98 standing (HR \n___ throughout) \nWt = 84kg (pt reports typical weight at home over past years is \n185 lbs = 84kg)\nGeneral: NAD, pleasant, lying comfortably on back\nHEENT: NCAT, EOMI, PERRL, mucous membranes dry\nNeck: JVD to just above clavicle at 45 degrees\nCV: irregular, no m/g/r\nLungs: breathing comfortably w/out accessory muscle use, \nbibasilar crackles\nAbdomen: soft, NT/ND, +BS, no masses\nGU: no foley\nExt: 2+ DP pulses, no c/c/e\nNeuro: A&Ox3, CNII-XII intact, moving all extremities equally\nSkin: no rashes or lesions\n\nDischarge physical exam:\nVS: Wt= 83.9 kg T=98.7 BP=103-134/64-94 ___ RR=18 O2 sat=97 \nRA \n(pt reports typical weight at home over past years is 185 lbs = \n84kg)\nGeneral: NAD, pleasant, lying comfortably on back\nHEENT: NCAT, EOMI, PERRL, mucous membranes dry\nNeck: JVD to just above clavicle at 45 degrees\nCV: irregular, no m/g/r\nLungs: breathing comfortably w/out accessory muscle use, \nbibasilar crackles\nAbdomen: soft, NT/ND, +BS, no masses\nGU: no foley\nExt: 2+ DP pulses, no c/c/e', 'diagnoses': [{'icd_code': '6820', 'desc': 'Cellulitis and abscess of face'}], 'summary': "Admission labs:\n___ 08:00AM BLOOD WBC-7.9 RBC-4.91 Hgb-14.1 Hct-44.2 MCV-90 \nMCH-28.6 MCHC-31.9 RDW-14.9 Plt Ct-93*\n___ 08:00AM BLOOD Neuts-87.9* Lymphs-7.7* Monos-3.5 Eos-0.7 \nBaso-0.2\n___ 08:00AM BLOOD Plt Smr-LOW Plt Ct-93*\n___ 08:00AM BLOOD ___ PTT-35.9 ___\n___ 08:00AM BLOOD Glucose-190* UreaN-52* Creat-1.6* Na-139 \nK-4.0 Cl-104 HCO3-27 AnGap-12\n___ 08:00AM BLOOD Calcium-9.7 Phos-3.0 Mg-2.4\n\nDischarge labs:\n___ 06:35AM BLOOD Glucose-108* UreaN-32* Creat-1.4* Na-142 \nK-4.3 Cl-107 HCO3-26 AnGap-13\n___ 06:35AM BLOOD Calcium-9.4 Phos-3.1 Mg-2.2\n\nPertinent labs:\n___ 08:00AM BLOOD proBNP-950*\n___ 08:00AM BLOOD cTropnT-<0.01\n___ 07:15PM BLOOD cTropnT-<0.01\n___ 06:35AM BLOOD CK-MB-1 cTropnT-<0.01\n\nEcho ___:\nThe left atrial volume index is moderately increased. The right \natrium is moderately dilated. Left ventricular wall thicknesses \nare normal. The left ventricular cavity is moderately dilated. \nThere is severe global left ventricular hypokinesis (LVEF = 20 \n%) secondary to global contractile dysfunction and dyssynchrony. \nThe right ventricular free wall thickness is normal. The right \nventricular cavity is mildly dilated with moderate global free \nwall hypokinesis. The aortic valve leaflets (3) are mildly \nthickened but aortic stenosis is not present. No aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. Moderate to severe (3+) mitral regurgitation is seen. \nThe tricuspid valve leaflets are mildly thickened. Moderate [2+] \ntricuspid regurgitation is seen. There is moderate pulmonary \nartery systolic hypertension. Significant pulmonic regurgitation \nis seen. There is no pericardial effusion.\nMr. ___ is a ___ old man with history of metastatic \ntesticular cancer s/p chemotherapy and resection, prostate \ncancer s/p prostatectomy, recurrent SBO, and atrial fibrillation \nand heart failure (EF 20%, tachycardia vs. chemotheraphy \nmediated) diagnosed prior to admission, who presented with \nlightheadedness and ___. Pt appeared to be volume depleted, and \nlightheadedness improved w/ fluids. Creatinine also improved to \n1.4, though not yet back to baseline (1.1 earlier this month) at \ntime of discharge. \n\n#Lightheadedness - Could have been due to rapid afib, but more \nlikely due to dehydration, given positional nature, ___, and \nimprovement w/ fluids. Pt had just started lasix 3 weeks ago and \nhas been restricting fluid intake as well. Pt's vitals not \northostatic on the floor, but by the time he had reached the \nfloor, he had taken in some fluids and the lightheadedness had \nresolved. ACS less likely given no chest pain, sx \nnon-exertional, negative trop x3. Pt's home furosemide 20mg \ndaily was held. On discharge, pt will discontinue daily lasix \nand in place do prn lasix if weight gain of 3 or more pounds. Pt \nhad not lightheadedness on discharge.\n\n#Systolic heart failure - EF 20% on echo ___. proBNP 950. \nEtiology unclear - tachycardiomyopathy from afib vs. \nchemotherapy (pt believes he was on Adriamycin). On exam, slight \ncrackles but no lower extremity edema. CXR does show some \npulmonary vascular congestion, potentially with mild \ninterstitial edema at the bases. Pt endorses dyspnea on \nexertion, but much improved over the past month, since \ninitiation of medical management for heart failure. Orthopnea \nalso improved and pt able to sleep flat. Echo this admission \nshowed that EF remains 20%. Pt will follow-up with Dr. ___ in \nheart failure clinic.\n\n#Atrial fibrillation - currently rate controlled. pt denies \npalpiations or dyspnea. pt continued on home carvedilol, \namiodarone, and rivaroxaban (though rivaroxaban dose decreased \ndue to ___ - see transitional issues below). pt planning for \ncardioversion ___ after amio loading.\n\n#Acute kidney injury - Creatinine 1.6 on admission, up from 1.1 \nat ___ on ___. Likely pre-renal due to diuresis, \nand BUN/creatinine ratio consistent w/ this (52/1.6 = 32.5). \nFeUrea (0.03%) and FeNa (0.57%) also consistent w/ pre-renal \netiology. The ___ did not appear to be due to cardiorenal \nsyndrome, as pt appeared euvolemic on exam and was asymptomatic \nother than mild DOE (no edema, no orthopnea). As above, standing \nfurosemide discontinued, in favor of pen dosing. Creatinine 1.4 \non discharge, and pt instructed to have repeat BMP in 1 week."}}
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{'final_diagnoses': ['Heart failure with reduced ejection fraction', 'Atrial fibrillation'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ old man with history of metastatic \ntesticular cancer s/p chemotherapy and resection, prostate \ncancer s/p prostatectomy, recurrent SBO, and atrial fibrillation \nand heart failure (EF 20%, tachycardia vs. chemotheraphy \nmediated) diagnosed prior to admission, who presented with \nlightheadedness and ___. Pt appeared to be volume depleted, and \nlightheadedness improved w/ fluids. Creatinine also improved to \n1.4, though not yet back to baseline (1.1 earlier this month) at \ntime of discharge. \n\n#Lightheadedness - Could have been due to rapid afib, but more \nlikely due to dehydration, given positional nature, ___, and \nimprovement w/ fluids. Pt had just started lasix 3 weeks ago and \nhas been restricting fluid intake as well. Pt's vitals not \northostatic on the floor, but by the time he had reached the \nfloor, he had taken in some fluids and the lightheadedness had \nresolved. ACS less likely given no chest pain, sx \nnon-exertional, negative trop x3. Pt's home furosemide 20mg \ndaily was held. On discharge, pt will discontinue daily lasix \nand in place do prn lasix if weight gain of 3 or more pounds. Pt \nhad not lightheadedness on discharge.\n\n#Systolic heart failure - EF 20% on echo ___. proBNP 950. \nEtiology unclear - tachycardiomyopathy from afib vs. \nchemotherapy (pt believes he was on Adriamycin). On exam, slight \ncrackles but no lower extremity edema. CXR does show some \npulmonary vascular congestion, potentially with mild \ninterstitial edema at the bases. Pt endorses dyspnea on \nexertion, but much improved over the past month, since \ninitiation of medical management for heart failure. Orthopnea \nalso improved and pt able to sleep flat. Echo this admission \nshowed that EF remains 20%. Pt will follow-up with Dr. ___ in \nheart failure clinic.\n\n#Atrial fibrillation - currently rate controlled. pt denies \npalpiations or dyspnea. pt continued on home carvedilol, \namiodarone, and rivaroxaban (though rivaroxaban dose decreased \ndue to ___ - see transitional issues below). pt planning for \ncardioversion ___ after amio loading.\n\n#Acute kidney injury - Creatinine 1.6 on admission, up from 1.1 \nat ___ on ___. Likely pre-renal due to diuresis, \nand BUN/creatinine ratio consistent w/ this (52/1.6 = 32.5). \nFeUrea (0.03%) and FeNa (0.57%) also consistent w/ pre-renal \netiology. The ___ did not appear to be due to cardiorenal \nsyndrome, as pt appeared euvolemic on exam and was asymptomatic \nother than mild DOE (no edema, no orthopnea). As above, standing \nfurosemide discontinued, in favor of pen dosing. Creatinine 1.4 \non discharge, and pt instructed to have repeat BMP in 1 week.", 'medications_prescribed': ['Amiodarone 400 mg PO BID', 'Carvedilol 12.5 mg PO BID', 'Rivaroxaban 15 mg PO DAILY \nRX *rivaroxaban [___] 15 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*0', 'Lisinopril 5 mg PO DAILY \nRX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', 'Furosemide 20 mg PO DAILY:PRN weight gain of 3 or more pounds']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 69, 'gender': 'F', 'symptoms': 'chest pain', 'medical_history': ['- Coronary artery disease status post POBA ___ and ___', '- Hypertension', '- Hyperlipidemia', '- History of CVA without significant deficit', '- COPD', '- Hematuria', '- GERD with premalignant ___', '- Benign positional vertigo', '- Migraines with aura', '- Status-post removal of benign testicular tumor in ___', '- Eczema', '- Peripheral neuropathy', '- Possible TB. (as noted in OMR: The patient reports he was diagnosed with this after he was liberated from a ___ camp in ___. He reports that he had a markedly abnormal chest x-ray at that \ntime. He was brought here in ___ and at that time says \nthat he was treated with some type of syrup. He does not \nknow how long he took this medication for. He does not \nthink he ever had surgery for this disease.)', '- BPH', 'CARDIAC RISK FACTORS:: Dyslipidemia, Hypertension', 'CARDIAC HISTORY: \n- POBA ___ and ___ see below)'], 'family_history': 'There is no family history of premature coronary artery disease, unexplained heart failure, or sudden death. \nPatient lost all of his family in the ___', 'present_illness': 'Patient is a very pleasant ___ year old male with past medical history of coronary artery disease, hypertension, hyperlipidemia, COPD, and CVA who presents with chest pain. \n. \nThe patient reports that his morning he noted substernal chest pain that felt similar to his prior episodes requiring POBA. He denies feeling shortness of breath, nausea, dizziness, or other symptoms. He took his morning medications, and the pain resolved. He was scheduled to speak as a Holocaust survior at an event in the late morning and felt he could not miss this. Later in the afternoon, as he was bringing in wood for his stove, he felt short of breath and again felt the chest pain. He decided to come in for evaluation. \n. \nOf note, patient is very concerned about the fact that he stopped his Diltiazem in ___ at the request of Dr. ___, ___ feels that he has been worse since that time. He felt that the diltiazem kept his "heart in good health." He reports that he has not had anginal symptoms for a very long time, and that his admission in ___ for chest discomfort was prompted by very different symptoms that were more consistent with GERD. \n. \nUpon presentation to the emergency room, his vital signs were HR 120, BP 153/64, RR 16, 95% on RA. He was given 325 mg ASA, 5 mg IV lopressor, then 5 mg and 10 mg IV diltiazem with improvement in HR to 80\'s. He also received his ___ coreg dose of 3.125 mg and 30 mg of PO diltiazem. An EKG was completed and faxed to cardiology, who felt that ST changes were secondary to his tachycardia. Throughout his entire ED stay, he was asymptomatic. \n\n. \nUpon arrival to the floor, the patient reports he feels well and has no symptoms. \n. \nOn review of systems, he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain except as noted above. All of the other review of systems were negative. He had a prior stroke, without any residual deficits. No GI/GU symptoms. \n. \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope, except as noted above.', 'medications': [{'medication': 'Midodrine', 'proc_type': 'Discharge Med', 'status': 'Active', 'route': 'PO', 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TiCAGRELOR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Loratadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TiCAGRELOR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '221', 'valuenum': 221.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '307', 'valuenum': 307.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.8', 'valuenum': 42.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 199.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: T 97.6, BP 139/86, HR 55, RR 18, 96% on RA, 80.3 kg \nGENERAL: Very pleasant elderly male appearing stated age, in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple with JVP of 7 cm. \nCARDIAC: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. + Tatoos \nPULSES: \nRight: Carotid 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': 'I671', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}], 'summary': "CXR: No evidence of CHF or pneumonia. Hiatal hernia\n.\nLab Results:\n___ 07:35PM BLOOD WBC-6.6 RBC-4.67 Hgb-15.3 Hct-43.0 MCV-92 \nMCH-32.7* MCHC-35.4* RDW-13.5 Plt ___\n___ 09:10AM BLOOD WBC-5.2 RBC-4.13* Hgb-13.4* Hct-38.5* \nMCV-93 MCH-32.4* MCHC-34.7 RDW-13.3 Plt ___\n___ 05:41AM BLOOD WBC-6.5 RBC-4.18* Hgb-13.5* Hct-38.3* \nMCV-92 MCH-32.2* MCHC-35.2* RDW-13.7 Plt ___\n___ 07:35PM BLOOD Neuts-58.7 ___ Monos-7.4 Eos-6.8* \nBaso-0.5\n.\n___ 07:35PM BLOOD ___ PTT-26.6 ___\n___ 09:10AM BLOOD ___ PTT-29.7 ___\n___ 05:41AM BLOOD ___ PTT-39.2* ___\n.\n___ 07:35PM BLOOD Glucose-108* UreaN-20 Creat-1.0 Na-141 \nK-4.0 Cl-105 HCO3-26 AnGap-14\n___ 09:10AM BLOOD Glucose-92 UreaN-19 Creat-1.0 Na-142 \nK-4.1 Cl-107 HCO3-31 AnGap-8\n___ 05:41AM BLOOD Glucose-91 UreaN-20 Creat-0.9 Na-141 \nK-3.8 Cl-104 HCO3-30 AnGap-11\n.\n___ 07:35PM BLOOD CK(CPK)-93\n___ 02:05AM BLOOD CK(CPK)-69\n___ 09:10AM BLOOD CK(CPK)-63\n___ 07:35PM BLOOD cTropnT-<0.01\n___ 02:05AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 09:10AM BLOOD CK-MB-NotDone cTropnT-0.01\n.\n___ 09:10AM BLOOD Calcium-9.2 Phos-2.8 Mg-1.8\n___ 05:41AM BLOOD Calcium-9.0 Phos-2.6* Mg-2.0\n.\n___ 07:35PM BLOOD TSH-2.1\nPatient is a ___ year old male with past medical history of coronary artery disese, hypertension, hyperlipidemia, COPD, and GERD who presents with chest pain, found to be tachycardic in the ED, determined to be atrial flutter. \n. \n# Chest pain/CORONARIES: The patient has known coronary artery disease with angioplasty in ___ and ___ of the LAD. However, the patient had a recent stress test 2 months ago without evidence of worsening coronary artery disease. The patient also had three sets of cardiac enzymes which were negative. Most likely the etiology of the chest pain was demand ischemia secondary to atrial flutter, see below. Initially continued aggrenox, but then switched to aspirin only as started on coumadin for a flutter. Also, continued metoprolol, statin, and imdur for medical management of his coronary artery disease. \n. \n# PUMP: The patient has no history of CHF. No features to suggest volume overload during hospitalization. Mild transient dyspnea on exertion could also be secondary to COPD. \n. \n# RHYTHM: Patient's baseline was sinus bradycardia, however in the ED found to have atypical atrial flutter, as atrial rate of 110's-120's relatively slow for atrial flutter. Electrolytes and TSH were within normal limits. The patient was monitored on telemetry with no other episodes of atrial flutter. EP was consulted for further evaluation. They recommended starting coumadin with lovenox bridge for anticoagulation. They also recommended diltiazem 15mg BID and carvedilol 6.25mg BID for rate control. The patient will be sent home with ___ of hearts monitor to determine if the patient has subsequent episodes of atrial flutter. The patient will follow up with Dr. ___ Dr. ___ further treatment of his atrial flutter, with the possibility of ablation/pacer placement if it returns.\n. \n# BPH: Continued home medications. \n. \n# Hypertension: Well controlled during hospitalization. Continued on carvedilol at increased dose, diltiazem and imdur. \n\n. \n# Hyperlipidemia: Continued statin \n. \n# CVA: Discussed with patient's Neurologist if it would be necessary for the patient to remain on aggrenox with coumadin. Decided it was not necessary, and aspirin and coumadin would be sufficient.\n. \n# FEN: Cardiac diet \n. \n# ACCESS: PIV \n. \n# PROPHYLAXIS: PPI, heparin SQ \n. \n# CODE: Full Code \n. \n# Communication: ___ ___"}}
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{'final_diagnoses': ['Atrial Flutter', 'Coronary Artery Disease', 'Hypertension', 'Hyperlipidemia', 'Chronic Obstructive Pulmonary Disease', 'Gastroesophageal reflux disease'], 'procedures': ['none.'], 'visit_summary': "Patient is a ___ year old male with past medical history of coronary artery disese, hypertension, hyperlipidemia, COPD, and GERD who presents with chest pain, found to be tachycardic in the ED, determined to be atrial flutter. \n. \n# Chest pain/CORONARIES: The patient has known coronary artery disease with angioplasty in ___ and ___ of the LAD. However, the patient had a recent stress test 2 months ago without evidence of worsening coronary artery disease. The patient also had three sets of cardiac enzymes which were negative. Most likely the etiology of the chest pain was demand ischemia secondary to atrial flutter, see below. Initially continued aggrenox, but then switched to aspirin only as started on coumadin for a flutter. Also, continued metoprolol, statin, and imdur for medical management of his coronary artery disease. \n. \n# PUMP: The patient has no history of CHF. No features to suggest volume overload during hospitalization. Mild transient dyspnea on exertion could also be secondary to COPD. \n. \n# RHYTHM: Patient's baseline was sinus bradycardia, however in the ED found to have atypical atrial flutter, as atrial rate of 110's-120's relatively slow for atrial flutter. Electrolytes and TSH were within normal limits. The patient was monitored on telemetry with no other episodes of atrial flutter. EP was consulted for further evaluation. They recommended starting coumadin with lovenox bridge for anticoagulation. They also recommended diltiazem 15mg BID and carvedilol 6.25mg BID for rate control. The patient will be sent home with ___ of hearts monitor to determine if the patient has subsequent episodes of atrial flutter. The patient will follow up with Dr. ___ Dr. ___ further treatment of his atrial flutter, with the possibility of ablation/pacer placement if it returns.\n. \n# BPH: Continued home medications. \n. \n# Hypertension: Well controlled during hospitalization. Continued on carvedilol at increased dose, diltiazem and imdur. \n\n. \n# Hyperlipidemia: Continued statin \n. \n# CVA: Discussed with patient's Neurologist if it would be necessary for the patient to remain on aggrenox with coumadin. Decided it was not necessary, and aspirin and coumadin would be sufficient.\n. \n# FEN: Cardiac diet \n. \n# ACCESS: PIV \n. \n# PROPHYLAXIS: PPI, heparin SQ \n. \n# CODE: Full Code \n. \n# Communication: ___ ___", 'medications_prescribed': ['1. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day).', '2. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime).', '3. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO twice a day.', '5. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '6. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___. Disp:*30 Tablet(s)* Refills:*2*', '7. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day). Disp:*60 Tablet(s)* Refills:*2*', '8. Diltiazem HCl 30 mg Tablet Sig: 0.5 Tablet PO BID (2 times a \nday). Disp:*30 Tablet(s)* Refills:*2*', '9. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) Subcutaneous \nBID (2 times a day). Disp:*14 syringes* Refills:*2*', '10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '11. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'M', 'symptoms': 'Acute Blood Loss Anemia, GI Bleeding', 'medical_history': ['COPD', 'dCHF', 'atrial fibrillation, reportedly previously on anticoagulation but\nnone recently due to GI bleeding', 'recurrent GI Bleeding, angiodysplasias s/p APC, GEJ ulcer', 'BPH', 'peripheral neuropathy'], 'family_history': 'no colon ca, no cancers\nfather with emphysema', 'present_illness': '___ year old Male recently discharged from ___ due to recurrent \nGI bleeding from AVMs andG-E Junction ulcer presents with 3 \ndays of melena and weakness. Patient was admitted in ___ for \na very similar presentation. The patient on his last admit \nunderwent an endoscopy and capsule endoscopy (capsule positive \nfor blood in proximal small bowel) and then underwent 2push \nenteroscopies which did not find any lesions other than prior \nscope trauma and erosions in the stomach (which were \ncauterized). He was ultimately transfused 3 units of PRBCs \nduring that admission. Now presenting with similar symptoms of 3 \ndays of melena; patient denies other symptoms including pain, \nnausea/vomiting, chest pain or dyspnea accompanying the melena. \nHowever, he does note significant weakness.\n\nInitial vital signs in the ___ ED, 99.6, 50, 120/50, 20, 98%. \nHe was given 250cc of NS and pantoprazole IV. he was seen by the \nGI consult team in the ED, who felt he should be admitted for \nlikely repeat endoscopy and that he can eat clear liquids \npending the studies. He will be treated with PO PPI. He was \ngiven 1 unit of PRBCs in the ED prior to transfer.', 'medications': [{'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pioglitazone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '2.79', 'valuenum': 2.79, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58.9', 'valuenum': 58.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.64', 'valuenum': 5.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.38', 'valuenum': 0.38, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.75', 'valuenum': 0.75, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.81', 'valuenum': 5.81, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '49.1', 'valuenum': 49.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 76.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 177.0, 'flag': None, 'priority': 'STAT', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 58.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 76.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 175.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 66.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '226', 'valuenum': 226.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.35', 'valuenum': 5.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.9', 'valuenum': 46.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 151.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '226', 'valuenum': 226.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.48', 'valuenum': 5.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.7', 'valuenum': 46.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'ROS:\n GEN: - fevers, - Chills, - Weight Loss\n EYES: - Photophobia, - Visual Changes\n HEENT: - Oral/Gum bleeding\n CARDIAC: - Chest Pain, - Palpitations, - Edema\n GI: - Nausea, - Vomiting, - Diarrhea, - Abdominal Pain, - \nConstipation, - Hematochezia, + Melena\n PULM: - Dyspnea, - Cough, - Hemoptysis\n HEME: - Bleeding, - Lymphadenopathy\n GU: - Dysuria, - hematuria, - Incontinence\n SKIN: - Rash\n ENDO: - Heat/Cold Intolerance\n MSK: - Myalgia, - Arthralgia, - Back Pain\n NEURO: - Numbness, + Weakness, - Vertigo, - Headache\nRemainder of 10-point ROS negative except as above\n\nPHYSICAL EXAM:\n\nVSS: 97.6, 127/65, 52, 16, 94%\n GEN: NAD, Cachexia\n Pain: ___\n HEENT: EOMI, MMM, - OP Lesions, HOH (has hearing aids in \nplace), poor dentition\n PUL: CTA B/L\n COR: RRR, S1/S2, II/VI SEM LSB\n ABD: NT/ND, +BS, - CVAT, paraumbilical hernia (reducible)\n EXT: - CCE\n NEURO: CAOx3, Motor ___/ ___ Flex/Ext', 'diagnoses': [{'icd_code': 'E662', 'desc': 'Morbid (severe) obesity with alveolar hypoventilation'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'Z6844', 'desc': 'Body mass index [BMI] 60.0-69.9, adult'}, {'icd_code': 'L97811', 'desc': 'Non-pressure chronic ulcer of other part of right lower leg limited to breakdown of skin'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'I2723', 'desc': 'Pulmonary hypertension due to lung diseases and hypoxia'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'E1140', 'desc': 'Type 2 diabetes mellitus with diabetic neuropathy, unspecified'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'B354', 'desc': 'Tinea corporis'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'I872', 'desc': 'Venous insufficiency (chronic) (peripheral)'}, {'icd_code': 'Z993', 'desc': 'Dependence on wheelchair'}], 'summary': "___ 09:00PM BLOOD WBC-4.5 RBC-2.29* Hgb-7.0* Hct-22.3* \nMCV-97 MCH-30.6 MCHC-31.4* RDW-16.6* RDWSD-58.5* Plt ___\n___ 09:00PM BLOOD Neuts-60.9 ___ Monos-9.2 Eos-5.6 \nBaso-0.7 Im ___ AbsNeut-2.73 AbsLymp-1.05* AbsMono-0.41 \nAbsEos-0.25 AbsBaso-0.03\n___ 09:00PM BLOOD ___ PTT-31.7 ___\n___ 09:00PM BLOOD Glucose-104* UreaN-76* Creat-2.5* Na-142 \nK-4.7 Cl-100 HCO3-28 AnGap-14\n___ 08:50PM URINE Color-Straw Appear-Clear Sp ___\n___ 08:50PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\n___ 8:50 pm URINE\n\n URINE CULTURE (Pending):\n\nECG Study Date of ___ 5:57:00 ___ \n Intervals Axes \nRate PR QRS QT QTc (___) P QRS T \n47 ___ 12 25 \n\n# Capsule Endoscopy (___): 1) Non-bleeding gastritis\n2) Non-bleeding AVMs in proximal and mid small bowel may\nrepresent source of bleeding 3) Erythematous spots in proximal \nsmall bowel of unclear clinical significance 4) Poor prep in \ndistal small bowel limits detection of small lesions\n\n# EGD (___): normal mucosa in whole esophagus, esophageal \nhiatal hernia, normal mucosa in whole stomach, normal mucosa in \nwhole examined duodenum.\nHospital Course: ___ M h/o h/o CKD, HFpEF, hiatal hernia with \n___ erosions, recurrent GI bleeding likely due to AVM's, \npresenting with concern for upper GI bleed.\n\n# Acute Blood Loss Anemia due to GI Bleeding: \n Mr. ___ was admitted with GI bleeding - similar to his prior \nadmissions. As noted in his medical records, he undergone \ncolonoscopy, capsule endoscopy x2, and upper endoscopies (SBE, \npush, EGD) x5 in the last year without meaningfully changing the \ncourse of his bleeding. The bleeding was attributed to AVM's \nlocated in the small intestine (multiple in jejunum).\n During this hospitalization, GI was consulted. Capsule \nendoscopy revealed mult AVMs without signs of active bleeding. \nEGD was also done - which was completely normal. A prior \n___ was no longer visualized. His Hgb remained stable \nduring the hospitalization with small amounts of blood in the \nstool.\n He received 1u pRBC on ___, largely to provide a buffer, in \ncase a future bleed were to occur. Mr. ___ is likely \ntransfusion dependent and PRN for any future bleeds. \n For future recurrences, repeat procedures (like endoscopy) or \nadmissions are unlikely to be beneficial as Mr. ___ has known \nmultiple AVM's which are prone to bleed. These bleeds cannot be \nfully prevented - as they bleed intermittently, and often \nresolves by the time an endoscopy is done. The multiplicity of \nAVMs also make it impossible to address all possible sites. \n He will continue on PO PPI. He tolerated regular diet \nwithout difficulty. He was discharged in good/stable \ncondition. \n\n# COPD \n - Continue albuterol, Spiriva \n\n# CKD Stage 3: stable\n - Renal dose medications \n - Avoid nephrotoxins such as dye loads, NSAIDs \n\n# Chronic Diastolic CHF \n - cont home diuretics \n\n# Afib with bradycardia\n - Not on anticoagulation due to ongoing bleeding \n - Telemetry \n \n# FEN: regular diet\n# DVT ppx: pneumoboots, active bleeding \n# Full code w/ limited trial of life-sustaining treatment."}}
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{'final_diagnoses': ['Upper GI bleeding', 'Atrial fib', 'COPD'], 'procedures': ['Capsule Study ___', 'EGD ___'], 'visit_summary': "Hospital Course: ___ M h/o h/o CKD, HFpEF, hiatal hernia with \n___ erosions, recurrent GI bleeding likely due to AVM's, \npresenting with concern for upper GI bleed.\n\n# Acute Blood Loss Anemia due to GI Bleeding: \n Mr. ___ was admitted with GI bleeding - similar to his prior \nadmissions. As noted in his medical records, he undergone \ncolonoscopy, capsule endoscopy x2, and upper endoscopies (SBE, \npush, EGD) x5 in the last year without meaningfully changing the \ncourse of his bleeding. The bleeding was attributed to AVM's \nlocated in the small intestine (multiple in jejunum).\n During this hospitalization, GI was consulted. Capsule \nendoscopy revealed mult AVMs without signs of active bleeding. \nEGD was also done - which was completely normal. A prior \n___ was no longer visualized. His Hgb remained stable \nduring the hospitalization with small amounts of blood in the \nstool.\n He received 1u pRBC on ___, largely to provide a buffer, in \ncase a future bleed were to occur. Mr. ___ is likely \ntransfusion dependent and PRN for any future bleeds. \n For future recurrences, repeat procedures (like endoscopy) or \nadmissions are unlikely to be beneficial as Mr. ___ has known \nmultiple AVM's which are prone to bleed. These bleeds cannot be \nfully prevented - as they bleed intermittently, and often \nresolves by the time an endoscopy is done. The multiplicity of \nAVMs also make it impossible to address all possible sites. \n He will continue on PO PPI. He tolerated regular diet \nwithout difficulty. He was discharged in good/stable \ncondition. \n\n# COPD \n - Continue albuterol, Spiriva \n\n# CKD Stage 3: stable\n - Renal dose medications \n - Avoid nephrotoxins such as dye loads, NSAIDs \n\n# Chronic Diastolic CHF \n - cont home diuretics \n\n# Afib with bradycardia\n - Not on anticoagulation due to ongoing bleeding \n - Telemetry \n \n# FEN: regular diet\n# DVT ppx: pneumoboots, active bleeding \n# Full code w/ limited trial of life-sustaining treatment.", 'medications_prescribed': ['Albuterol Inhaler 2 PUFF IH Q6H:PRN sob', 'Betamethasone Dipro 0.05% Cream 1 Appl TP DAILY:PRN itch', 'Bumetanide 1 mg PO BID', 'Cyanocobalamin 1000 mcg PO DAILY', 'Docusate Sodium 100 mg PO BID:PRN Constipation - First Line', 'Ferrous Sulfate 325 mg PO DAILY', 'Finasteride 5 mg PO DAILY', 'Fluticasone Propionate NASAL 1 SPRY NU DAILY', 'FoLIC Acid 1 mg PO DAILY', 'HydrOXYzine 25 mg PO QHS:PRN unkonwn', 'Incruse Ellipta (umeclidinium) 62.5 mcg/actuation \ninhalation DAILY', 'Pantoprazole 40 mg PO BID', 'Pravastatin 20 mg PO QPM', 'Sertraline 50 mg PO DAILY', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \ninhalation BID', 'Tamsulosin 0.4 mg PO QHS', 'Thiamine 100 mg PO DAILY', 'Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID:PRN \nitch', 'Vitamin D 1000 UNIT PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 89, 'gender': 'M', 'symptoms': 'Chest pain', 'medical_history': ['Diabetes', 'Dyslipidemia', 'Hypertension', 'Heavy tobacco use (quit ___', 'Peripheral Vascular Diseases/p Aortobifemoral bypass ___ \ncomplicated with a small non ST segment elevation Myoacardial \nInfarction, treated with Cypher stenting of a 90% RCA stenosis', 'Episodes of rhabdomyolsis likely in the setting of nonsteroidal \nabuse and kidney failure'], 'family_history': 'Father with CAD', 'present_illness': '___ man with history of diabetes, hyperlipidemia, \nhistory of heavy smoking, peripheral vascular disease, status \npost aortofemoral bypass last ___ complicated with a small non \nST segment elevation MI, followed by recurrent unstable angina a \nmonth later, treated with Cypher stenting of a 90% RCA stenosis, \nsubsequent episodes of rhabdomyolsis likely in the setting of \nnonsteroidal abuse and kidney failure, returns feeling well. \nPresented to outside facility with chest pain, hypotension and \nVTac, found to have elevated St segment in aVR. On cath Lab here \n@ BI, found to have >90 L main, which progress from a moderate \nlesion back in ___. RCA stent is patent with moderate distal \ndisease. Upon encounter in Cath lab, pt denied CP, he is off any \npressors, no IABP, occasional PVCs on monitor.', 'medications': [{'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '0.84', 'valuenum': 0.84, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.6', 'valuenum': 84.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '422', 'valuenum': 422.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.78', 'valuenum': 3.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.15', 'valuenum': 0.15, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.59', 'valuenum': 0.59, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.17', 'valuenum': 9.17, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '42.6', 'valuenum': 42.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 386.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely decreases this test.'}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE RANGE AS OF ___.'}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1, . estimated GFR (eGFR) is likely between 63 and >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 185.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '344', 'valuenum': 344.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '___', 'valuenum': 6.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '378', 'valuenum': 378.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '357', 'valuenum': 357.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.32', 'valuenum': 3.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.9', 'valuenum': 41.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '497', 'valuenum': 497.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '321', 'valuenum': 321.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '291', 'valuenum': 291.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse: 62 Resp: 14 O2 sat: 100% RA \nB/P Left: 156/54\n\nGeneral: AAO x 3 in mild distress\nSkin: Dry [x] intact [x] [x] Right arm tatoo\nHEENT: PERRLA [x] EOMI [x] Exopthalmous\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] No Murmur\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds \n+ [x]\nExtremities: Warm [x], well-perfused [x] Edema []\nNeuro: Grossly intact\n\nPulses:\nFemoral Right:2+ Left:2+\nDP Right:2+ Left:2+\n___ Right:2+ Left:2+\nRadial Right:2+ Left:2+\n\nCarotid Bruit Right: none Left: none', 'diagnoses': [{'icd_code': 'C250', 'desc': 'Malignant neoplasm of head of pancreas'}, {'icd_code': 'K831', 'desc': 'Obstruction of bile duct'}, {'icd_code': 'E222', 'desc': 'Syndrome of inappropriate secretion of antidiuretic hormone'}, {'icd_code': 'K311', 'desc': 'Adult hypertrophic pyloric stenosis'}, {'icd_code': 'K315', 'desc': 'Obstruction of duodenum'}, {'icd_code': 'D352', 'desc': 'Benign neoplasm of pituitary gland'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'K259', 'desc': 'Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation'}, {'icd_code': 'K269', 'desc': 'Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation'}, {'icd_code': 'R600', 'desc': 'Localized edema'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'I951', 'desc': 'Orthostatic hypotension'}, {'icd_code': 'R110', 'desc': 'Nausea'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'E860', 'desc': 'Dehydration'}], 'summary': '___ Cath: 1. Selective coronary angiography of this right \ndominant system demonstrated two vessel disease. The left main \nhad a hazy 80% proximal stenosis. The LAD had mild diffuse \ndisease. The LCx had a 70% distal stenosis. The RCA had a 40% \nproximal narrowing. The mid-RCA stent was patent without \n___ disease. 2. Limited resting \nhemodynamics revealed mild central aortic hypertension with SBP \n150mmHg. 3. Left ventriculography was deferred.\n___ 05:30AM BLOOD WBC-3.1*# RBC-2.65* Hgb-8.1* Hct-24.4* \nMCV-92 MCH-30.5 MCHC-33.2 RDW-14.5 Plt ___\n___ 08:20PM BLOOD WBC-5.5 RBC-3.68* Hgb-10.7* Hct-32.3* \nMCV-88 MCH-29.0 MCHC-33.0 RDW-14.8 Plt ___\n___ 01:59PM BLOOD ___ PTT-29.1 ___\n___ 08:20PM BLOOD ___ PTT-90.4* ___\n___ 05:30AM BLOOD Glucose-144* UreaN-50* Creat-2.5* Na-143 \nK-4.7 Cl-107 HCO3-26 AnGap-15\n___ 08:20PM BLOOD Glucose-121* UreaN-20 Creat-1.4* Na-142 \nK-4.1 Cl-111* HCO3-24 AnGap-11\n___ 01:59PM BLOOD ALT-12 AST-33 AlkPhos-47 Amylase-63 \nTotBili-0.___\n___ was taken to the operating room for an emergent \ncoronary artery bypass graft x 2 (Left internal mammary artery \ngrafted to left anterior descending artery/Saphenous vein \ngrafted to Obtuse Marginal) with ___. Please see \noperative report for surgical details. Cross clamp time= 26 \nminutes. Cardiopulmonary Bypass time= 33 minutes. He was \nintubated, sedated, and transferred to the CVICU in critical but \nstable condition. Within 24 hours he was weaned from sedation, \nawoke neurologically intact and extubated. All lines and drains \nwere removed in a timely fashion. Beta-blocker/Statin/aspirin , \nand diuresis was initiated. He continued to progress and was \ntransferred to the telemetry floor for further care. Physical \ntherapy was consulted for evaluation to increase strength and \nmobility.The remainder of his postoperative course was \nessentially uneventful. On POD#5 he was cleared for discharge to \nhome by ___. All follow up appointments were \nadvised.'}}
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{'final_diagnoses': ['Coronary Artery Disease s/p Emergent Coronary Artery Bypass \nGraft x 2', 'Past medical history:', 'Diabetes', 'Dyslipidemia', 'Hypertension', 'Heavy tobacco use (quit ___', 'Peripheral Vascular Diseases/p Aortobifemoral bypass ___ \ncomplicated with a small non ST segment elevation Myoacardial \nInfarction, treated with Cypher stenting of a 90% RCA stenosis', 'Episodes of rhabdomyolsis likely in the setting of nonsteroidal \nabuse and kidney failure'], 'procedures': ['___ Emergent Coronary Artery Bypass Graft x 2 (Left internal \nmammary artery to left anterior descending, saphenous vein graft \nto obtuse marginal)'], 'visit_summary': '___ was taken to the operating room for an emergent \ncoronary artery bypass graft x 2 (Left internal mammary artery \ngrafted to left anterior descending artery/Saphenous vein \ngrafted to Obtuse Marginal) with ___. Please see \noperative report for surgical details. Cross clamp time= 26 \nminutes. Cardiopulmonary Bypass time= 33 minutes. He was \nintubated, sedated, and transferred to the CVICU in critical but \nstable condition. Within 24 hours he was weaned from sedation, \nawoke neurologically intact and extubated. All lines and drains \nwere removed in a timely fashion. Beta-blocker/Statin/aspirin , \nand diuresis was initiated. He continued to progress and was \ntransferred to the telemetry floor for further care. Physical \ntherapy was consulted for evaluation to increase strength and \nmobility.The remainder of his postoperative course was \nessentially uneventful. On POD#5 he was cleared for discharge to \nhome by ___. All follow up appointments were \nadvised.', 'medications_prescribed': ['1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).\nDisp:*60 Tablet(s)* Refills:*2*', '2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', '3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', '4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*60 Tablet(s)* Refills:*2*', '5. Rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*60 Tablet(s)* Refills:*2*', '6. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*45 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 27, 'gender': 'M', 'symptoms': '1. Recurrent hematuria.\n2. Benign prostatic hypertrophy.\n3. Prostatic urethral stone', 'medical_history': ['HTN, labile', 'Dyslipidemia', 'H/o DVT, right leg', 'Asthmatic bronchitis', 'Graves disease/hyperthyroidism'], 'family_history': 'No family history of venous thromboembolism. No other \ncontributory family history', 'present_illness': '___ year old retired MD who presents for surgical intervention \ngiven his persistent lower urinary tract symptoms.', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Flecainide Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mupirocin Cream 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Triamcinolone Acetonide 0.1% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyanocobalamin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '391', 'valuenum': 391.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.30', 'valuenum': 4.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'WDWN male, nad, avss\nabdomen soft, nt/nd\nextremities w/out edema, pitting, pain\nfoley has been removed. He is voiding frequently and feels safe \nto go home. PVRs have been checked and have been around \n150-200cc.', 'diagnoses': [{'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '7863', 'desc': 'Hemoptysis'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}], 'summary': "NONE for this admission\nDr. ___ was admitted to Dr. ___ service after laser \nlithotripsy of stone and limited transurethral resection of \nprostate. No concerning intraoperative events occurred; please \nsee dictated operative note for details. Dr. ___\n___ antibiotic prophylaxis and the postoperative \ncourse was uncomplicated. He received intravenous antibiotics \nand remained overnight for pain, control, monitoring for \nhematuria. On POD1, Foley was removed after active voiding trial \nand post void residuals were checked. His urine was clear yellow \nand without clots. He remained a-febrile throughout his hospital \nstay. At discharge, the patient's pain well controlled with \noral pain medications, tolerating regular diet, ambulating \nwithout assistance, and voiding without difficulty. He is given \noral pain medications on discharge and a course of antibiotics \nand instruction on resuming CIC if necessary, on discharge home. \nDr. ___ will follow up with Dr. ___ in clinic, as directed."}}
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{'final_diagnoses': ['Recurrent hematuria.', 'Benign prostatic hypertrophy.', 'Prostatic urethral stone.'], 'procedures': ['Laser lithotripsy of stone.', 'Limited transurethral resection of prostate.'], 'visit_summary': "Dr. ___ was admitted to Dr. ___ service after laser \nlithotripsy of stone and limited transurethral resection of \nprostate. No concerning intraoperative events occurred; please \nsee dictated operative note for details. Dr. ___\n___ antibiotic prophylaxis and the postoperative \ncourse was uncomplicated. He received intravenous antibiotics \nand remained overnight for pain, control, monitoring for \nhematuria. On POD1, Foley was removed after active voiding trial \nand post void residuals were checked. His urine was clear yellow \nand without clots. He remained a-febrile throughout his hospital \nstay. At discharge, the patient's pain well controlled with \noral pain medications, tolerating regular diet, ambulating \nwithout assistance, and voiding without difficulty. He is given \noral pain medications on discharge and a course of antibiotics \nand instruction on resuming CIC if necessary, on discharge home. \nDr. ___ will follow up with Dr. ___ in clinic, as directed.", 'medications_prescribed': ['Acetaminophen 650 mg PO Q8H:PRN pain', 'Albuterol Inhaler 1 PUFF IH DAILY:PRN shortness of breath', 'Aspirin 325 mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Levothyroxine Sodium 125 mcg PO DAILY', 'Methimazole 20 mg PO DAILY', 'Metoprolol Tartrate 75 mg PO BID', 'OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg HALF tableT by mouth Q4HRS Disp #*15 Tablet \nRefills:*0', 'Cephalexin 250 mg PO Q12H Duration: 5 Days \nRX *cephalexin [Keflex] 250 mg ONE capsule(s) by mouth twice a \nday Disp #*10 Capsule Refills:*0', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium [Colace] 100 mg ONE capsule(s) by mouth \ntwice a day Disp #*60 Capsule Refills:*0', 'Senna 8.6 mg PO DAILY Duration: 2 Doses']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'F', 'symptoms': 'Chest pain', 'medical_history': ['1. CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension', '2. CARDIAC HISTORY: \n- CABG: \n- PERCUTANEOUS CORONARY INTERVENTIONS: none\n- PACING/ICD: PPM s/p PVI for afib', '3. OTHER PAST MEDICAL HISTORY: \n1. Asymmetric hypertrophic nonobstructive cardiomyopathy, EF \n>55%, septal wall thickness 2.5 cm', '2. Paroxysmal afib s/p PVIx2 and ___ PPM for sinus node \ndysfunction with AV nodal ablation in ___', '3. History of moderate diastolic dysfunction', '4. Chronic atypical chest pain without obstructive coronary \nartery disease on angiography ___.', '5. Hypertension', '6. Dyslipidemia', '7. OSA on CPAP at 15 cmH2O/2L/min O2', '8. GERD', '9. h/o Polysubstance abuse'], 'family_history': 'Mother with hypertension and arthritis. Father with diabetes and \ncolon cancer. Cancer in 2 uncles and aunt on the paternal side. \nBrother with diabetes who required a leg amputation for \ncomplications. Older brother has diabetes. Brother with HIV and \ncancer. Sister with hypertension. No family history of early MI, \narrhythmia, cardiomyopathies, or sudden cardiac death; otherwise \n___.', 'present_illness': '___ male chronic smoker and CAD presenting with \nshortness of breath. \nThe ___ reports having episodes of shortness of breath 5 \ndays ago and was seen in the emergency department. He was sent \nhome after course of nebulizers, steroids, azithromycin. ___ \nreports that he initially felt improved. Since his course of \nsteroids and azithromycin. However, the ___ began to feel \nshort of breath again at 12:30 am today while watching TV. He \nconcurrently developed chest pressure at rest that does not \nradiate or change with breathing which is different from his \nchronic chest pain. He denies any changes in diet. Notes that \nover the past week has felt febrile occasionally and has felt \nsome chills. Notes abdominal distension over the past week as \nwell without change in BM or pain. Has some nausea but no \nvomiting over past week. Denies ___ swelling or pain. Denies \ndysuria, diarrhea, constipation, arthralgias, or myalgias. He \nalso endorses difficulty with laying flat. \n In the ED, initial vitals were: 98 82 178/85 18 99% RA \n - Labs were significant for troponin of 0.02 and BNP of 2229 \n - Imaging revealed question of right upper lobe pneumonia \n - The ___ was given azithromycin 500mg, ceftriaxone 1gram, \naspirin 243mg, morphine sulphate 5mg x1, x2 duonebs, and \nprednisone 40mg. \n Vitals prior to transfer were: 98.4 68 166/89 24 95% RA \n Upon arrival to the floor, ___ reports he is still short of \nbreath. \n REVIEW OF SYSTEMS: \n (+) Per HPI', 'medications': [{'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen w/Codeine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '67.9', 'valuenum': 67.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '523', 'valuenum': 523.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1000', 'valuenum': 1000.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 340.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 10.5, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 255.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '67.8', 'valuenum': 67.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '524', 'valuenum': 524.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.2, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 195.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE. TITER IS BETWEEN 15 AND 100 MIU/ML. PROTECTIVE TITERS ARE >10 MIU/ML.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mIU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 100000.0, 'flag': None, 'priority': 'STAT', 'comments': '<5. VALUES <5 ARE NEGATIVE;VALUES 5-25 ARE EQUIVOCAL;VALUES >25 ARE POSITIVE.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '437', 'valuenum': 437.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.6', 'valuenum': 63.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '523', 'valuenum': 523.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '396', 'valuenum': 396.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 217.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '265', 'valuenum': 265.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '525', 'valuenum': 525.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '341', 'valuenum': 341.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Exam:\n=========================\n Vitals:T98.9 BP 159/64 HR 84 Sats 98RA \n General: Alert, oriented, no acute distress \n HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL \n Neck: Supple, JVP not elevated, no LAD \n CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \n Lungs: Crackles throughout all lung fields with scattered \nwheeze \n Abdomen: Soft, ___, distended, bowel sounds present, no \norganomegaly, no rebound or guarding \n GU: No foley \n Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \n Neuro: ___ intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, gait \ndeferred. \n\nDischarge Physical Exam:\n=========================\n Vitals- afebrile BP ___ HR ___ RR 18 SpO2 96% \non RA.\n General- Alert, oriented, no acute distress \n HEENT- Sclera anicteric, MMM, oropharynx clear \n Neck- supple, JVP not elevated, no LAD \n Lungs- Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \n CV- Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \n Abdomen- distended but soft, bowel sounds present, no rebound \ntenderness or guarding \n GU- no foley \n Ext- warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \n Neuro- motor function grossly normal', 'diagnoses': [{'icd_code': '6144', 'desc': 'Chronic or unspecified parametritis and pelvic cellulitis'}, {'icd_code': '6142', 'desc': 'Salpingitis and oophoritis not specified as acute, subacute, or chronic'}, {'icd_code': '09954', 'desc': 'Other venereal diseases due to chlamydia trachomatis, other genitourinary sites'}, {'icd_code': '25053', 'desc': 'Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled'}, {'icd_code': '36204', 'desc': 'Mild nonproliferative diabetic retinopathy'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}], 'summary': 'Admission Labs:\n===================\n___ 01:30AM BLOOD ___\n___ Plt ___\n___ 01:30AM BLOOD ___\n___ Im ___\n___\n___ 01:30AM BLOOD ___ ___\n___ 01:30AM BLOOD ___\n___\n___ 01:30AM BLOOD ___\n___ 01:30AM BLOOD ___\n___ 01:30AM BLOOD ___\n___ 01:30AM BLOOD ___\n___ 01:30AM BLOOD ___\n\nUrine:\n===================\n___ 03:30AM URINE ___ Sp ___\n___ 03:30AM URINE ___\n___\n___ 03:30AM URINE ___\n\nMicro:\n===================\n# Blood Cx x2 (___): Negative\n# Blood Cx (___): BLOOD/FUNGAL CULTURE (Preliminary): NO \nFUNGUS ISOLATED. \nBLOOD/AFB CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n \n___ 4:21 pm BRONCHOALVEOLAR LAVAGE\n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n RESPIRATORY CULTURE (Final ___: \n Commensal Respiratory Flora Absent. \n YEAST. ~3000/ML. \n\n LEGIONELLA CULTURE (Final ___: NO LEGIONELLA \nISOLATED. \n\n POTASSIUM HYDROXIDE PREPARATION (Final ___: \n ___ ___ TO BE RUN ___ (___). \n BUDDING YEAST WITH PSEUDOHYPHAE. \n This is a low yield procedure based on our ___ \nstudies. \n\n Immunoflourescent test for Pneumocystis jirovecii (carinii) \n(Final\n ___: NEGATIVE for Pneumocystis jirovecii \n(carinii). \n\n FUNGAL CULTURE (Final ___: \n YEAST. \n\n NOCARDIA CULTURE (Preliminary): NO NOCARDIA ISOLATED. \n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n\n Respiratory Viral Culture (Final ___: \n No respiratory viruses isolated. \n Culture screened for Adenovirus, Influenza A & B, \nParainfluenza type\n 1,2 & 3, and Respiratory Syncytial Virus..\n Detection of viruses other than those listed above will \nonly be\n performed on specific request. Please call Virology at \n___\n within 1 week if additional testing is needed. \n\n Respiratory Viral Antigen Screen (Final ___: \n Negative for Respiratory Viral Antigen. \n Specimen screened for: Adeno, Parainfluenza 1, 2, 3, \nInfluenza A, B,\n and RSV by immunofluorescence. \n Refer to respiratory viral culture and/or Influenza PCR \n(results\n listed under "OTHER" tab) for further information.\n\n Legionella Urinary Antigen (Final ___: \n NEGATIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN. \n\n C. difficile DNA amplification assay (Final ___: \n Negative for toxigenic C. difficile by the Illumigene DNA\n amplification assay. \n (Reference ___. \n Blood Culture, Routine (Final ___: NO GROWTH. \n URINE CULTURE (Final ___: NO GROWTH. \n\nImaging:\n=======================\n# CXR (___): Prelim - New right upper lobe opacity could \nrepresent pneumonia in the correct clinical setting. \n\n# CT Chest w/o contrast (___): \nWidespread peribronchial ___ and nodular opacities with \n___ halo throughout the lungs have developed since the \nrecent ___. Imaging appearance of widespread infection most \nsuggestive of fungal infection, or bacterial. \n\n# TTE (___)\nThere is moderate biatrial enlargement. The estimated right \natrial pressure is at least 15 mmHg. There is asymmetric left \nventricular hypertrophy. The left ventricular cavity size is \nnormal. Right ventricular chamber size and free wall motion are \nnormal. The aortic arch is mildly dilated. The aortic valve \nleaflets (3) appear structurally normal with good leaflet \nexcursion and no aortic stenosis. Trace aortic regurgitation is \nseen. The mitral valve leaflets are mildly thickened. There is \nno mitral valve prolapse. Mild to moderate (___) mitral \nregurgitation is seen. There is moderate pulmonary artery \nsystolic hypertension. There is no pericardial effusion. \n\n Compared with the prior study (images reviewed) of ___, \npulmonary artery systolic pressure is higher. Other findings are \nsimilar. \n\n# CXR (___)\nWorsening pulmonary vascular congestion and Multifocal pneumonia \n.\n\n# CT Abd/pelvis (___)\n \n1. Moderate sized right flank hematoma interdigitating within \nthe oblique \nmusculature. No focal collections. \n2. Significant interval worsening of consolidation in the lung \nbases. \n3. Mild diverticulosis without evidence of acute diverticulitis. \n\n4. Nonobstructing left renal calculi. \n\n# CXR (___)\nEsophageal catheter terminates in the body of the stomach. \nOther support and monitoring devices are unchanged in position. \nSince a prior study of 1 day earlier, pulmonary edema has \nsubstantially improved. Left retrocardiac opacity has worsened, \nand adjacent small to moderate left pleural effusion has \napparently increased in size. No other relevant changes. \n\n \n# CT Abd/pelvis (___)\n \n1. Diffusely mildly distended GI tract consistent with ileus. \n2. The NG tube terminates in the esophagus. \n3. Collapsed IVC suggesting dehydration. \n\n# CXR (___)\nCompared to ___ 15 radiograph, a nasogastric tube has \nbeen placed, with tip terminating in the proximal stomach. \nCardiomediastinal contours are stable. Pulmonary vascular \ncongestion has improved and accompanying edema has nearly \nresolved in the interval. Additional improved aeration at both \nlung bases. Distended loops of bowel in the imaged upper \nabdomen are incompletely evaluated on this chest radiograph \nexam. At the time of this dictation, a portable abdomen \nradiograph has been scheduled. \n\n# KUB (___)\nCompared to ___ 15 radiograph, a nasogastric tube has \nbeen placed, with tip terminating in the proximal stomach. \nCardiomediastinal contours are stable. Pulmonary vascular \ncongestion has improved and accompanying edema has nearly \nresolved in the interval. Additional improved aeration at both \nlung bases. Distended loops of bowel in the imaged upper \nabdomen are incompletely evaluated on this chest radiograph \nexam. At the time of this dictation, a portable abdomen \nradiograph has been scheduled. \n\nPathology\n=======================\n# Bronchial lavage ___:\nNEGATIVE FOR MALIGNANT CELLS\n- Numerous pulmonary macrophages, neutrophils, rare degenerated \nbronchial epithelial cells.\nNote: Special stains (GMS and PAS) are performed on cell block \nsections and show yeast forms\n\nDischarge Labs:\n===================\n\n___ 06:30AM BLOOD ___\n___ Plt ___\n___ 06:30AM BLOOD Plt ___\n___ 06:30AM BLOOD ___\n___\n___ 06:30AM BLOOD ___\n\nOther labs: \n===================\n\n___ 11:56AM BLOOD ___\n___ 05:21AM BLOOD ___\n___ 04:57AM BLOOD ___\n___ 03:06AM BLOOD ___\n___ 09:59PM BLOOD ___ B\n___ 09:59PM BLOOD ___\n___ 05:00PM BLOOD HIV ___\n___ 09:59PM BLOOD ___ B\n___ 05:21AM BLOOD ___\n___ 08:30PM BLOOD ___\n___ 07:30PM BLOOD ___\n___ 07:00PM BLOOD ___ cTropnT-<0.01\n___ 04:55PM BLOOD ___ cTropnT-<0.01\n___ 10:45AM BLOOD ___\n___ 09:33AM BLOOD ___ cTropnT-<0.01\n___ 01:30AM BLOOD ___\n___ 01:30AM BLOOD ___\n___ 02:50AM BLOOD ___\n___ 09:00AM BLOOD ___\n___ 09:00AM BLOOD ___\n___ 03:00AM BLOOD ___\n___\n___ Tear ___\n___\nInformation for Outpatient Providers: ___ with dCHF (EF 55%), \nHTN, afib (s/p AVN ablation and pacemaker, on Xarelto), OSA, \nreactive airway disease,obesity, tobacco dependence, and a hx of \nsubstance abuse who presented to the hospital with dyspnea, \nfound to have new diffuse ground glass opacities on CT chest, \nhemoptypsis and a new R flank hemorrhage. He was initially \ntreated for a CHF and COPD exacerbation with little improvement. \nHe was transferred to MICU for hypoxemic respiratory failure and \nput on broad spectrum antibiotics with fungal coverage for five \ndays with spontaneous improvement. He then developed abdominal \npain, ___, and increased abdominal girth with elevated bladder \npressures consistent with compartment syndrome. \n\n# DYSPNEA/HYPOXEMIC RESIPIRATORY FAILURE: ___ symptoms \nwere multifactorial with an element of PNA, reactive airway \ndisease as well as mild volume overload (up 7 lbs from discharge \nweight). He was treated with CTX/Azithro in the ED and then \nnarrowed to Doxycycline. He was also treated with steroids and \nnebulizers. He was diuresed with Lasix IV x 2 days but was \nlimited by ___ (see below). On ___, ___ had chest pain and \nwas ruled out for NSTEMI (see below) and continued to have \nshortness of breath, mildly improved with duonebs. On ___, he \ncontinued to have almost constant chest pain and shortness of \nbreath. On ___, ___ started on IV vanc/zoysn for HCAP, \ncontinued on doxy for atypical coverage. Sputum samples were \nsent but poor samples. CT chest on ___ showed extensive \npulmonary infiltrates and ___ was evaluated by Pulmonology. \nFrom ___ overnight, ___ was hypoxemic with new oxygen \nrequirement (going from RA to 6 L overnight). He also coughed \nseveral tablespoons of blood. Bronchoscopy with pulm was \ndeferred in setting of acute hypoxemia and elevated INR in \nsetting of rivaroxaban use. Interventional pulmonology \nevaluated ___ and were also hesistant to perform \nbronchoscopy in setting of coagulopathy. Per pulm \nrecommendations, the following labs were sent and pending at \ntime of transfer to the MICU: serum galactomannan and fungal \nblood cultures, CRP/ESR, ANCA, ___, urine histo, urine \nlegionella. By mid morning ___, ___ with SpO2 90% on NRB \nwith increased work of breathing. ABG pH 7.44 pO2 53 pCO2 37, \nlactate 1.6. Transferred to ___ for ongoing treatment of \nhypoxemic respiratory failure. He had a bronchoscopy and BAL \nthat showed no malignant cells and he was treated with \nvanco/cefepime/levofloxacin for HCAP course. ___ had an \ninitial beta glucan that was positive and started on \nvoriconazole. ___ was also started on bactrim for possible \nPCP given ground glass opacities were seen on CT chest however \nBactrim and voriconazole were discontinued as repeat ___ \nwas ___ is not immunosuppressed/BAL was negative \nfor PCP/fungal organisms therefore likelihood of PCP/fungal \npneumonia was thought to be low. He was treated with steroids \nhowever his respiratory status did not improve so they were \ndiscontinued. Additionally, he was given IV diuresis to help \nimprove his respiratory status. Given lack of improvement after \ntreatment with antibiotics, steroids, and diuresis the ___ \nwas treated for ARDS with ___ protocol. His respiratory \nfailure resolved, however he remained intubated due to abdominal \nhypertension. He was extubated after resolution of his abdominal \nhypertension. Please see description of this problem below. On \nthe medical floor, ___ continued to improve from a \nrespiratory standpoint and required IV Lasix boluses in the \ncontext of high volume intake (TPN) while NGT in place. He is \nbeing discharged on PO Lasix.\n\n# ABDOMINAL HYPERTENSION: Upon transfer to ICU ___, ___ \nbegan developing abdominal distension and constipation. He \nreported having abdominal distension since 1 month prior to this \nadmission. Bladder pressure was found to be 48 on ___. Imaging \nshowed intestinal distension consistent with ileus. ACS was \nconsulted and recommended surgery, however urine output, \nlactate, creatinine, and abdominal pressures downtrended with \nconservative management, which included paralysis (to relax \nabdominal wall muscles), GI decompression with NGT and bowel \nrest. Creatinine on discharge was 1.0 compared to his baseline \ncreatinine of ___. C. diff was negative and etiology of \nabdominal hypertension was thought to be ___ to ___ \nileus with possible contribution from verapamil given the long \nchronicity of his abdominal symptoms. ___ was given \nmethylnatrexone and treated conservatively with resolution of \nhis abdominal hypertension with NG tube placement for \ndecompression. While NG in place, ___ put on TPN for \ngreater than seven days without oral intake. NG tube was \nclamped, ___ started on clears, with good improvement. NG \nremoved, TPN discontinued, and ___ tolerated a regular diet.\n\n#OPIOID WITHDRAWAL- in context of heavy sedation in MICU, \n___ transferred to floor on methadone taper. ___ not \ndischarged on methadone. \n\n# CHEST PAIN - ___ with hx of chronic chest pain with clean \ncath in ___. Trop mildly elevated at 0.02 in ED. Acute episode \nof CP on ___ with negative cardiac enzymes. Unable to interpret \nEKG as ___. Of note, ___ with negative stress MIBI on \n___. Pain was relieved with morphine. It was thought that \npain was likely ___ pulmonary process prior to transfer to MICU. \n When ___ transferred back to medical floor, he had several \n___ minutes of chest pain with palpitations w/ persistently low \nelevation in troponin (___) which completely resolved with \nAtivan, c/w panic attacks. \n\n # ___ with ___ with uptrending Ct to 2.7 above \nbaseline 1.1. ___ with negative renal US for \nhydronephrosis. Likely a combination of ___ azotemia as \nwell as abdominal hypertension. Resolved after resolution of \nabdominal hypertension. \n\n # RLQ PAIN- ___ with new RLQ pain on ___ and ___. \nPatients exam without peritoneal signs and ___ found to have \nlarge hematoma on right flank. LFTs normal and lipase sent and \nmildly elevated. Pain resolved w/ conservative management. \n\n #LEUKOCYTOSIS- ___ with uptrending WC, thought initially to \nbe occuring in setting of steroids but with recent CT findings, \nmost likely occuring in setting of infection. Leukocytosis \ndowntrended after resolution of abdominal hypertension. \n\n # HYPERGLYCEMIA: HgbA1c 6.6%- new diagnosis of DM2. ___ on \nISS while in house with sugars ___. \n\nCHRONIC ISSUES: \n========================\n#Chronic Pain: continued home gabapentin 800mg qD, tramadol 50mg \nBID. Briefly held in MICU while sedated and intubated. \n#Afib: rivaroxiban 20mg qD held for flank hematoma, restarted on \ndischarge. Amiodarone 200mg qD discontinued for possible \npulmonary toxicity. \n#Reactive airway disease: continued fluticasone, albuterol \n#GERD: coninued omeprazole 40mg qD \n#HLD: continued home atorva 40mg qHS \n#HTN: originally continued home verapamil ER 360mg qD, \ndiscontinued in MICU and then restarted when on the floor'}}
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{'final_diagnoses': ['- Hypoxemic respiratory failure', '- Abdominal compartment syndrome', '- Acute kidney injury', '- COPD exacerbation', '- Acute on chronic systolic and diastolic heart failure \nexacerbation', '- Hypertrophic cardiomyopathy', '- Atrial fibrillation s/p AVN with pacemaker', '- Tobacco abuse'], 'procedures': ['None'], 'visit_summary': 'Information for Outpatient Providers: ___ with dCHF (EF 55%), \nHTN, afib (s/p AVN ablation and pacemaker, on Xarelto), OSA, \nreactive airway disease,obesity, tobacco dependence, and a hx of \nsubstance abuse who presented to the hospital with dyspnea, \nfound to have new diffuse ground glass opacities on CT chest, \nhemoptypsis and a new R flank hemorrhage. He was initially \ntreated for a CHF and COPD exacerbation with little improvement. \nHe was transferred to MICU for hypoxemic respiratory failure and \nput on broad spectrum antibiotics with fungal coverage for five \ndays with spontaneous improvement. He then developed abdominal \npain, ___, and increased abdominal girth with elevated bladder \npressures consistent with compartment syndrome. \n\n# DYSPNEA/HYPOXEMIC RESIPIRATORY FAILURE: ___ symptoms \nwere multifactorial with an element of PNA, reactive airway \ndisease as well as mild volume overload (up 7 lbs from discharge \nweight). He was treated with CTX/Azithro in the ED and then \nnarrowed to Doxycycline. He was also treated with steroids and \nnebulizers. He was diuresed with Lasix IV x 2 days but was \nlimited by ___ (see below). On ___, ___ had chest pain and \nwas ruled out for NSTEMI (see below) and continued to have \nshortness of breath, mildly improved with duonebs. On ___, he \ncontinued to have almost constant chest pain and shortness of \nbreath. On ___, ___ started on IV vanc/zoysn for HCAP, \ncontinued on doxy for atypical coverage. Sputum samples were \nsent but poor samples. CT chest on ___ showed extensive \npulmonary infiltrates and ___ was evaluated by Pulmonology. \nFrom ___ overnight, ___ was hypoxemic with new oxygen \nrequirement (going from RA to 6 L overnight). He also coughed \nseveral tablespoons of blood. Bronchoscopy with pulm was \ndeferred in setting of acute hypoxemia and elevated INR in \nsetting of rivaroxaban use. Interventional pulmonology \nevaluated ___ and were also hesistant to perform \nbronchoscopy in setting of coagulopathy. Per pulm \nrecommendations, the following labs were sent and pending at \ntime of transfer to the MICU: serum galactomannan and fungal \nblood cultures, CRP/ESR, ANCA, ___, urine histo, urine \nlegionella. By mid morning ___, ___ with SpO2 90% on NRB \nwith increased work of breathing. ABG pH 7.44 pO2 53 pCO2 37, \nlactate 1.6. Transferred to ___ for ongoing treatment of \nhypoxemic respiratory failure. He had a bronchoscopy and BAL \nthat showed no malignant cells and he was treated with \nvanco/cefepime/levofloxacin for HCAP course. ___ had an \ninitial beta glucan that was positive and started on \nvoriconazole. ___ was also started on bactrim for possible \nPCP given ground glass opacities were seen on CT chest however \nBactrim and voriconazole were discontinued as repeat ___ \nwas ___ is not immunosuppressed/BAL was negative \nfor PCP/fungal organisms therefore likelihood of PCP/fungal \npneumonia was thought to be low. He was treated with steroids \nhowever his respiratory status did not improve so they were \ndiscontinued. Additionally, he was given IV diuresis to help \nimprove his respiratory status. Given lack of improvement after \ntreatment with antibiotics, steroids, and diuresis the ___ \nwas treated for ARDS with ___ protocol. His respiratory \nfailure resolved, however he remained intubated due to abdominal \nhypertension. He was extubated after resolution of his abdominal \nhypertension. Please see description of this problem below. On \nthe medical floor, ___ continued to improve from a \nrespiratory standpoint and required IV Lasix boluses in the \ncontext of high volume intake (TPN) while NGT in place. He is \nbeing discharged on PO Lasix.\n\n# ABDOMINAL HYPERTENSION: Upon transfer to ICU ___, ___ \nbegan developing abdominal distension and constipation. He \nreported having abdominal distension since 1 month prior to this \nadmission. Bladder pressure was found to be 48 on ___. Imaging \nshowed intestinal distension consistent with ileus. ACS was \nconsulted and recommended surgery, however urine output, \nlactate, creatinine, and abdominal pressures downtrended with \nconservative management, which included paralysis (to relax \nabdominal wall muscles), GI decompression with NGT and bowel \nrest. Creatinine on discharge was 1.0 compared to his baseline \ncreatinine of ___. C. diff was negative and etiology of \nabdominal hypertension was thought to be ___ to ___ \nileus with possible contribution from verapamil given the long \nchronicity of his abdominal symptoms. ___ was given \nmethylnatrexone and treated conservatively with resolution of \nhis abdominal hypertension with NG tube placement for \ndecompression. While NG in place, ___ put on TPN for \ngreater than seven days without oral intake. NG tube was \nclamped, ___ started on clears, with good improvement. NG \nremoved, TPN discontinued, and ___ tolerated a regular diet.\n\n#OPIOID WITHDRAWAL- in context of heavy sedation in MICU, \n___ transferred to floor on methadone taper. ___ not \ndischarged on methadone. \n\n# CHEST PAIN - ___ with hx of chronic chest pain with clean \ncath in ___. Trop mildly elevated at 0.02 in ED. Acute episode \nof CP on ___ with negative cardiac enzymes. Unable to interpret \nEKG as ___. Of note, ___ with negative stress MIBI on \n___. Pain was relieved with morphine. It was thought that \npain was likely ___ pulmonary process prior to transfer to MICU. \n When ___ transferred back to medical floor, he had several \n___ minutes of chest pain with palpitations w/ persistently low \nelevation in troponin (___) which completely resolved with \nAtivan, c/w panic attacks. \n\n # ___ with ___ with uptrending Ct to 2.7 above \nbaseline 1.1. ___ with negative renal US for \nhydronephrosis. Likely a combination of ___ azotemia as \nwell as abdominal hypertension. Resolved after resolution of \nabdominal hypertension. \n\n # RLQ PAIN- ___ with new RLQ pain on ___ and ___. \nPatients exam without peritoneal signs and ___ found to have \nlarge hematoma on right flank. LFTs normal and lipase sent and \nmildly elevated. Pain resolved w/ conservative management. \n\n #LEUKOCYTOSIS- ___ with uptrending WC, thought initially to \nbe occuring in setting of steroids but with recent CT findings, \nmost likely occuring in setting of infection. Leukocytosis \ndowntrended after resolution of abdominal hypertension. \n\n # HYPERGLYCEMIA: HgbA1c 6.6%- new diagnosis of DM2. ___ on \nISS while in house with sugars ___. \n\nCHRONIC ISSUES: \n========================\n#Chronic Pain: continued home gabapentin 800mg qD, tramadol 50mg \nBID. Briefly held in MICU while sedated and intubated. \n#Afib: rivaroxiban 20mg qD held for flank hematoma, restarted on \ndischarge. Amiodarone 200mg qD discontinued for possible \npulmonary toxicity. \n#Reactive airway disease: continued fluticasone, albuterol \n#GERD: coninued omeprazole 40mg qD \n#HLD: continued home atorva 40mg qHS \n#HTN: originally continued home verapamil ER 360mg qD, \ndiscontinued in MICU and then restarted when on the floor', 'medications_prescribed': ['1. Fluticasone Propionate 110mcg 2 PUFF IH BID', '2. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN \nsob/wheeze', '3. Aspirin 81 mg PO DAILY', '4. Fluticasone Propionate NASAL 2 SPRY NU BID', '5. Gabapentin 800 mg PO TID', '6. Nicotine Polacrilex 2 mg PO Q1H:PRN craving', '7. Omeprazole 40 mg PO DAILY', '8. Rivaroxaban 20 mg PO DAILY', '9. TraMADOL (Ultram) 50 mg PO BID \nRX *tramadol 50 mg 1 tablet(s) by mouth twice daily Disp #*60 \nTablet Refills:*0', '10. Verapamil SR 360 mg PO Q24H', '11. Lorazepam 0.5 mg PO Q8H:PRN anxiety \nRX *lorazepam [Ativan] 0.5 mg 1 tablet by mouth every eight \nhours Disp #*15 Tablet Refills:*0', '12. Atorvastatin 40 mg PO QPM', '13. Outpatient Physical Therapy\n___- Fatigue/ICD 9 780.7 \nRolling walker\nDx: Px: good, length of need: 13 mo.', '14. Furosemide 20 mg PO DAILY \nRX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 71, 'gender': 'F', 'symptoms': 'L knee pain', 'medical_history': ['claudication R>L', 'CAD c MI ___ years ago', 'cardiac stent ___', 'hyperlipidemia', 'obesity', 'hiatal hernia', 'sleep apnea', 'GERD', 'LBP', 'Spinal stenosis'], 'family_history': 'N/C', 'present_illness': '___ obese female with h/o peripheral vascular disease and \nbilateral knee pain with L being greater pain than R.', 'medications': [{'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen w/Codeine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'At the time of discharge:\nAVSS\nNAD\nwound c/d/i without erythema\n___ intact\nSILT distally', 'diagnoses': [{'icd_code': '6185', 'desc': 'Prolapse of vaginal vault after hysterectomy'}, {'icd_code': '6186', 'desc': 'Vaginal enterocele, congenital or acquired'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': "___ 06:45AM BLOOD WBC-9.6 RBC-3.18*# Hgb-9.3*# Hct-27.5*# \nMCV-87 MCH-29.3 MCHC-33.9 RDW-13.7 Plt ___\n___ 06:35AM BLOOD WBC-7.9 RBC-3.00* Hgb-8.6* Hct-25.8* \nMCV-86 MCH-28.6 MCHC-33.2 RDW-13.7 Plt ___\n___ 05:45AM BLOOD WBC-8.2 RBC-3.38* Hgb-9.8* Hct-29.1* \nMCV-86 MCH-29.0 MCHC-33.7 RDW-13.6 Plt ___\n\nPOD 2 xrays show good alignment of hardware without fracture\nThe patient was admitted on ___ and, later that day, was \ntaken to the operating room by Dr. ___ L total knee \narthroplasty without complication. Please see operative report \nfor details. Postoperatively the patient did well. The patient \nwas initially treated with a PCA followed by PO pain medications \non POD#1. The patient received IV antibiotics for 24 hours \npostoperatively, as well as lovenox for DVT prophylaxis starting \non the morning of POD#1. The patient was placed in a CPM \nmachine with range of motion that started at ___ degrees of \nflexion before being increased to 90 degrees as tolerated. The \ndrain was removed without incident on POD#1. The Foley catheter \nwas removed without incident. The surgical dressing was removed \non POD#2 and the surgical incision was found to be clean, dry, \nand intact without erythema or purulent drainage.\n\nWhile in the hospital, the patient was seen daily by physical \ntherapy. Labs were checked throughout the hospital course and \nrepleted accordingly. At the time of discharge the patient was \ntolerating a regular diet and feeling well. The patient was \nafebrile with stable vital signs. The patient's hematocrit was \nstable, and the patient's pain was adequately controlled on a PO \nregimen. The operative extremity was neurovascularly intact and \nthe wound was benign. The patient was discharged to home with \nservices in a stable condition. The patient's weight-bearing \nstatus was WBAT. The patient is to continue using the CPM \nmachine advancing as tolerated to ___ degrees."}}
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{'final_diagnoses': ['L knee OA'], 'procedures': ['___ L total knee arthroplasty'], 'visit_summary': "The patient was admitted on ___ and, later that day, was \ntaken to the operating room by Dr. ___ L total knee \narthroplasty without complication. Please see operative report \nfor details. Postoperatively the patient did well. The patient \nwas initially treated with a PCA followed by PO pain medications \non POD#1. The patient received IV antibiotics for 24 hours \npostoperatively, as well as lovenox for DVT prophylaxis starting \non the morning of POD#1. The patient was placed in a CPM \nmachine with range of motion that started at ___ degrees of \nflexion before being increased to 90 degrees as tolerated. The \ndrain was removed without incident on POD#1. The Foley catheter \nwas removed without incident. The surgical dressing was removed \non POD#2 and the surgical incision was found to be clean, dry, \nand intact without erythema or purulent drainage.\n\nWhile in the hospital, the patient was seen daily by physical \ntherapy. Labs were checked throughout the hospital course and \nrepleted accordingly. At the time of discharge the patient was \ntolerating a regular diet and feeling well. The patient was \nafebrile with stable vital signs. The patient's hematocrit was \nstable, and the patient's pain was adequately controlled on a PO \nregimen. The operative extremity was neurovascularly intact and \nthe wound was benign. The patient was discharged to home with \nservices in a stable condition. The patient's weight-bearing \nstatus was WBAT. The patient is to continue using the CPM \nmachine advancing as tolerated to ___ degrees.", 'medications_prescribed': ['1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous \nonce a day for 3 weeks.\nDisp:*21 * Refills:*0*', '2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours). ', '3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '4. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO QHS (once a day \n(at bedtime)) as needed. ', '5. Senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day) \nas needed. ', '6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '7. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '8. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '9. Multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). ', '10. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day). ', '11. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '12. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '13. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily). ', '14. Compression stalkings\nOne pair of 20 pound knee high compression stalkings to be worn \nwhen OOB.', '15. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours) as needed.\nDisp:*90 Tablet(s)* Refills:*0*', '16. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO BID (2 times a day) as needed. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 32, 'gender': 'M', 'symptoms': 's/p fall with dizziness prior', 'medical_history': ['1. Follicular lymphoma with blastic transformation \n - involvement of mesenteric lymph nodes and lung\n - s/p VATS with LUL wedge resection, mesenteric LN excisional \nbiopsy ___. \n - completed 6 cycles of CHOP, completed on ___.\n - currently receiving Rituxan', '2. Prostate cancer ___ years ago treated with XRT and maintained \non Lupron therapy ', '3. Atrial fibrillation, followed by Dr. ___ at ___. ', '4. Subdural hematoma after fall, while on Coumadin, \napproximately ___ years ago, requiring Burr Hole ', '5. s/p Cholecystectomy ', '6. Hernia repair (twice, after cholecystectomy) ', '7. Brochiectasis ', '8. B-12 deficiency ', '9. Skin cancer ', '10. Depression'], 'family_history': 'His mother died at age ___ of heart disease, and he has one \nsibling with myelodysplasia. His father died in his ___ at work \nas a ___.', 'present_illness': '___ y.o. male with h/o blastic transformation of follicular \nlymphoma ___, afib on coumadin, recent admission for gait \ninstability and fall with cardioversion, recent PPM placement \nfor unstable AF ___ s/p fall at home. Last admission \nincluded w/u by neurology who felt gait d/o to be \nmultifactorial. \nStates on ___ ___ got up to close blinds and fell backwards, \nbecame dizzy with position change. Hit head on carpeted floor. \nNo vertigo sx. C/o right ankle pain with edema. No LOC. No \ncp/sob. No n/v. Told to come to ED by oncologist for eval. \nIn ED EKG Vpaced, LAD, no obvious ST elevation, no change from \nprevious.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetylcysteine 20%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.010', 'valuenum': 1.01, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.4', 'valuenum': 19.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '68.2', 'valuenum': 68.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.31', 'valuenum': 4.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '310', 'valuenum': 310.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '382', 'valuenum': 382.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '508', 'valuenum': 508.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '472', 'valuenum': 472.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.17', 'valuenum': 4.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VITAL SIGNS: orthostatic VS standing 124/70, hr 70, sitting \n120/68 hr 70, standing 102/60 hr 78 \nGEN: NAD, alert, engaging. \nPain: ___ ___ with weightbearing to right ankel \nHEENT: EOMI, MMM, - OP Lesions \nPUL: bilateral rales L>R no rhonchi, wheezes \nCOR: RRR ap 72 \nABD: NT/ND, +BS, - CVAT, + umbilical/ventral hernia \nEXT: + trace right ankle edema, + tender with movement of foot \nNEURO: CAOx3, Non-Focal ___ strength bilat UE and bilat ___. \nSensation intact in bilat feet', 'diagnoses': [{'icd_code': '5770', 'desc': 'Acute pancreatitis'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V1581', 'desc': 'Personal history of noncompliance with medical treatment, presenting hazards to health'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': "___ 11:50AM GLUCOSE-99 UREA N-31* CREAT-1.2 SODIUM-137 \nPOTASSIUM-4.4 CHLORIDE-104 TOTAL CO2-25 ANION GAP-12\n___ 11:50AM CK(CPK)-125\n___ 11:50AM cTropnT-<0.01\n___ 11:50AM CK-MB-4\n___ 11:50AM WBC-4.5 RBC-3.15* HGB-9.8* HCT-29.8* MCV-95 \nMCH-31.0 MCHC-32.7 RDW-16.0*\n___ 11:50AM NEUTS-57.3 ___ MONOS-6.3 EOS-1.4 \nBASOS-0.4\n___ 11:50AM PLT COUNT-197\n___ 11:50AM ___ PTT-32.8 ___\n___ 05:45AM BLOOD Glucose-95 UreaN-28* Creat-1.2 Na-139 \nK-4.6 Cl-108 HCO3-23 AnGap-13\n# syncope/fall: Multifactorial- peripheral neuropathy from \nchemo, he was also orthostatic and slight inc BUN (21-->31 in 6 \ndays) Gait likely attributable to hydration status/orthostasis. \n\n- He r/o'd out for MI. No events on tele. \n- Head CT was negative for bleed.\n- He received one liter IV fluid. Remained orthostatic but was \nwithout complaints of dizziness, BUN down to 28. Given explicit \ninstructions on changing position slowly and also to increase PO \nfluids.\n- Plan should be established to hydrate him in outpatient clinic \nintermittently.\n \n# ankle injury: right ankle nondisplaced lateral malleolar \nfracture, no surgical intervention needed.\n- air cast when OOB\n- f/u orthopedics in two weeks. \n\n# afib/PPM s/p cardioversion ___: had supratherapeutic INR to \n2.3, coumadin held ___ and ___, will need INR ___ to be drawn \nby ___. \n\n# Follicular lymphoma with blastic transformation: He was \nscheduled for a CT of the torso in two days for evaluation of \nrecurrence of disease. We were able to have this down while \nin-house. If no recurrence plan was to restart rituxan. Results \nstill pending.\n\n# Persistent dizziness/gait problems: He had thorough workup \nduring admission in ___ including brain MRI which was \nunremarkable. It is possible that vincristine contributed to a \nperipheral neuropathy which is making his baseline gait \ndifficulties worse. Patient has declined lumbar puncture for \nfurther evaluation. \n- Oncology felt strongly that they wanted him evaluated by \ngeriatrics as an outpatient. An appointment has been made for \nhim ___ with the ___ at ___. \n\n# hypothyroidism: his TSH remained elevated at 5.36 so his \nlevothyroxine dose was increased to 25mcg and TSH should be \nrepeated in 6 weeks.\n\n# anemia: stable at baseline \n\n# b12 deficiency: continue replacement \n\n# hyperlipidemia: continue lipitor \n \n# depression: continue zoloft. \n\n#Advance Directives: \nHCP- daughter ___ who is RN at ___ \nCode Status- Full code but no prolonged intubation"}}
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{'final_diagnoses': ['Fall secondary to orthostasis', 'Mild dehydration', 'Right ankle nondisplaced lateral malleolar fracture', 'Non Hodgkins lymphoma with blastic transformation ', 'Hypothyroidism', 'Peripheral neuropathy', 'B12 deficiency', 'Afib s/p PPM, on coumadin', 'Bronchiectasis'], 'procedures': ['Head CT scan', 'Torso CT scan', 'EKG', 'Intravenous fluid'], 'visit_summary': "# syncope/fall: Multifactorial- peripheral neuropathy from \nchemo, he was also orthostatic and slight inc BUN (21-->31 in 6 \ndays) Gait likely attributable to hydration status/orthostasis. \n\n- He r/o'd out for MI. No events on tele. \n- Head CT was negative for bleed.\n- He received one liter IV fluid. Remained orthostatic but was \nwithout complaints of dizziness, BUN down to 28. Given explicit \ninstructions on changing position slowly and also to increase PO \nfluids.\n- Plan should be established to hydrate him in outpatient clinic \nintermittently.\n \n# ankle injury: right ankle nondisplaced lateral malleolar \nfracture, no surgical intervention needed.\n- air cast when OOB\n- f/u orthopedics in two weeks. \n\n# afib/PPM s/p cardioversion ___: had supratherapeutic INR to \n2.3, coumadin held ___ and ___, will need INR ___ to be drawn \nby ___. \n\n# Follicular lymphoma with blastic transformation: He was \nscheduled for a CT of the torso in two days for evaluation of \nrecurrence of disease. We were able to have this down while \nin-house. If no recurrence plan was to restart rituxan. Results \nstill pending.\n\n# Persistent dizziness/gait problems: He had thorough workup \nduring admission in ___ including brain MRI which was \nunremarkable. It is possible that vincristine contributed to a \nperipheral neuropathy which is making his baseline gait \ndifficulties worse. Patient has declined lumbar puncture for \nfurther evaluation. \n- Oncology felt strongly that they wanted him evaluated by \ngeriatrics as an outpatient. An appointment has been made for \nhim ___ with the ___ at ___. \n\n# hypothyroidism: his TSH remained elevated at 5.36 so his \nlevothyroxine dose was increased to 25mcg and TSH should be \nrepeated in 6 weeks.\n\n# anemia: stable at baseline \n\n# b12 deficiency: continue replacement \n\n# hyperlipidemia: continue lipitor \n \n# depression: continue zoloft. \n\n#Advance Directives: \nHCP- daughter ___ who is RN at ___ \nCode Status- Full code but no prolonged intubation", 'medications_prescribed': ['1. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO HS (at \nbedtime). ', '2. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '3. Cyanocobalamin 250 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '6. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H \n(Every 8 Hours) as needed for pain. ', '7. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a \nday). ', '8. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) \nTablet PO THREE TIMES PER WEEK (). ', '9. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO once a \nday.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'M', 'symptoms': 'Admission for chemotherapy', 'medical_history': ['Status post maxillary malignancy respected by orbital \nexoneration and maxillary resection in ___.', 'Esophageal cancer as above.'], 'family_history': 'No family history of malignancy.', 'present_illness': '___ ___ man with previous h/o head and neck cancer now \nwith new new diagnosis of squamous esophageal CA presenting for \nchemo/XRT. He presented initially in ___, underwent EGD on \n___ revealing mass and biopsy showed ___. PET showed \nmetastatic lesion to chest wall. EGD was done for stent \nplacement on ___ by ___ and ___ and eating has since \nbeen much improved. He had ___ chest port placed ___. On ROS, \nhe denies f/c. No bloody stools. No n/v. He does mention \nintermittent pain in chest over the past couple of weeks.', 'medications': [{'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mesalamine DR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.4', 'valuenum': 38.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '257', 'valuenum': 257.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.54', 'valuenum': 4.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '443', 'valuenum': 443.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '256', 'valuenum': 256.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '408', 'valuenum': 408.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.09', 'valuenum': 4.09, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '346', 'valuenum': 346.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '303', 'valuenum': 303.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VITALS: T 97.8 84 16 126/87 97 RA \nGENERAL: awake, alert, NAD \nHEENT: s/p L maxillary surgery with enucleation, r eye pupil \nreactive \nNECK: supple, no cervica, supraclavicular LAD \nCARD: RRR, no m/r/g \nRESP: ___ port c/d/i,m CTAB \nABD: soft, NT/ND \nEXT: w/d, no edema \nNEURO: awake, alert, MAEW', 'diagnoses': [{'icd_code': '57400', 'desc': 'Calculus of gallbladder with acute cholecystitis, without mention of obstruction'}, {'icd_code': '5761', 'desc': 'Cholangitis'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '57410', 'desc': 'Calculus of gallbladder with other cholecystitis, without mention of obstruction'}], 'summary': 'Na 139 K 4.1 Cl 104 HCO3 26 BUN 15 Creat 0.8 Gluc 104 \n.\nALT: 36 AST: 22 AP: 85 Tbili: 1.2 LDH: 162 \nGGT:60 \n.\nWBC 7.5 \n___: 5480 \nHgb 16.9 \nHct 48.5 \nPlt 331 \nMCV ___ ___ man with h/o head and neck cancer s/p resection \nand new diagnosis of squamous esophageal CA metastatic to lymph \nnode and chest wall presenting for chemo/XRT\n.\n1. Esophageal CA:\ns/p stent, here for chemo (cisplatin + fluorouracil) and XRT. Pt \ntolerated chemotherapy well. He is on a dysphagia diet. He will \nfollow-up with his oncologist.\n.\n2. Epigastric burning: thought to be possibly from mucositis of \nthe esophagus. Pt was started on magic mouth wash and continued \non his home PPI. He also had evidence of thrush and was started \non nystatin and chlorhexidine washes.'}}
|
{'final_diagnoses': ['Esophageal Cancer, chemotherapy with cisplatin and fluorouracil', 'Gastroesophageal Reflux Disease', 'Thrush (mild)'], 'procedures': ['chemotherapy: cisplatin and fluorouracil infusion'], 'visit_summary': '.\n1. Esophageal CA:\ns/p stent, here for chemo (cisplatin + fluorouracil) and XRT. Pt \ntolerated chemotherapy well. He is on a dysphagia diet. He will \nfollow-up with his oncologist.\n.\n2. Epigastric burning: thought to be possibly from mucositis of \nthe esophagus. Pt was started on magic mouth wash and continued \non his home PPI. He also had evidence of thrush and was started \non nystatin and chlorhexidine washes.', 'medications_prescribed': ['Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', 'Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for fever or pain.', 'Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO \nQ6H (every 6 hours) as needed for nausea.\nDisp:*10 Tablet(s)* Refills:*0*', '___ 200-25-400-40 mg/30 mL \nMouthwash Sig: Thirty (30) ML Mucous membrane four times a day \nas needed for heartburn for 1 months.\nDisp:*QS bottle* Refills:*2*', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) as needed for constipation.', 'Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID \n(4 times a day) for 5 days.\nDisp:*100 ML(s)* Refills:*0*']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 37, 'gender': 'F', 'symptoms': 'claudication', 'medical_history': ['HTN', 'hyperlipidemia', 'atypical chest pain', 'PVD', 'Dyslipidemia', 'COPD', 'GERD', 'Diverticulosis/diverticulitis', 'GIB', 'Myalgias', 'BPH', 'Bladder CA', 'depression', 'DM'], 'family_history': 'Mother died of a brain tumor at the age of ___. \nFather died of a myocardial infarction at the age of ___.', 'present_illness': '___ M w/ PVD and multiple prior ___ revascularization\nprocedures including multiple bypass grafts. He has not followed\nup in clinic for over a year. He reports that over the past 5\nmonths, he has had a progressive increase in claudication\nsymptoms to the point that now he can only walk around 100 ft\nbefore getting ___ severe L midfoot and calf pain. The pain is\nsignificantly decreased when the patient is sitting or laying\ndown. He states the pain is sharp/ stabbing/burning in quality.\nHe reports Chest Pain last evening which he has had worked up\nmultiple times in the past. He states that the pain is now gone.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'MR X1', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.006', 'valuenum': 1.006, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Straw', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '264', 'valuenum': 264.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVitals: 98.1 82 159/91 20 95% \nGen: AAO, NAD\n___: RRR, S1S2\nPulm: Prolonged Exp phase\nAbd: Soft, midline laparotomy scar, nontender, nondistended\nExt: No edema, warm, Well healed R. TMA amp site.\nVascular:\nPulses: Fem: bilateral palp\nPop: bilateral dop\nLeft: DP & ___ signals\nRight: AT signal\nGraft on left medial ___ is non dopplerable\n\nDISCHARGE PHYSICAL EXAM:\nVitals: 98.3 54 117/64 18 95%\nGen: AAO, NAD laying comfortably in bed\n___: RRR, normal S1/S2. No murmurs, rubs or gallops\nPulm: CTAB. Prolonged expiratory phase. No wheezes, rales or \nrhonchi\nAbd: +BS, soft, non-tender, non-distended. Midline laparotomy \nscar. \nExt: No edema. Warm. Well healed R TMA amp-site. \nVascular:\nPulses: Fem: bilateral palpation\nPop: bilateral doppler\nLeft: DP & ___ dopplerable\nRight: AT dopplerable.\nGraft on left medial ___ is non-dopplerable.', 'diagnoses': [{'icd_code': '72210', 'desc': 'Displacement of lumbar intervertebral disc without myelopathy'}, {'icd_code': '99889', 'desc': 'Other specified complications of procedures not elsewhere classified'}, {'icd_code': '78062', 'desc': 'Postprocedural fever'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}], 'summary': '___ 11:42PM BLOOD WBC-10.8 RBC-5.68 Hgb-16.5 Hct-49.8 \nMCV-88 MCH-29.0 MCHC-33.2 RDW-14.5 Plt ___\n___ 04:50PM BLOOD WBC-12.2*# RBC-6.14# Hgb-17.8# Hct-53.8*# \nMCV-88 MCH-29.1 MCHC-33.1 RDW-14.5 Plt ___\n___ 05:10AM BLOOD Glucose-111* UreaN-12 Creat-0.6 Na-138 \nK-4.3 Cl-108 HCO3-20* AnGap-14\n___ 11:42PM BLOOD Glucose-128* UreaN-14 Creat-0.5 Na-142 \nK-4.2 Cl-105 HCO3-26 AnGap-15\n___ 05:10AM BLOOD Calcium-9.8 Phos-2.8 Mg-1.6\n___ 11:42PM BLOOD Calcium-9.5 Phos-2.8 Mg-1.4*\n___ 11:42PM BLOOD %HbA1c-6.0* eAG-126*\n\nEXAMINATION: CTA AORTA/BIFEM/ILIAC RUNOFF W/ AND W/O C AND \nRECONS \n \nINDICATION: ___ year old man with rest pain multiple bypasses \n// iliac/tibial \npatency, anatomy \n \nTECHNIQUE: MDCT-acquired axial images were first acquired from \nthe lung bases \nthrough the feet using low radiation dose technique. Next, \nimmediately after \nrapid intravenous administration of 100 mL Omnipaque, early \narterial-phase \naxial images were acquired from the lung bases through the feet. \nLower \nextremity runoff images were obtained by scanning from the feet \nto the knees \nin reverse direction. Multiplanar reformations performed to \ngenerate 2.5 mm \nslice thickness axial images, coronal MIPs, and sagittal MIPs. \nCurved \nreformats, 3D MIPs, and volumetric rendering was performed by \nthe Imaging Lab, \non a separate 3D workstation. \n \nDOSE: DLP: 2469 mGy-cm. \n \nCOMPARISON: CT of the abdomen pelvis from ___ was \nreviewed. \n \nFINDINGS: \n \nCTA ABDOMEN/PELVIS: \n \nThe abdominal aorta is normal in caliber and without evidence of \naneurysmal dilation or dissection. The celiac axis, SMA, \nbilateral renal arteries, and ___ are grossly patent. There are \nbilateral endoluminal stent grafts extending from the aortic \nbifurcation in the common iliacs to the level of the external \niliacs bilaterally. There is internal soft plaque bilaterally \nwith mild to moderate stenosis of the right common and external \niliac artery (3a:112) and mild stenosis of the left external \niliac artery (3a:128). Atherosclerotic mural calcifications are \nseen throughout the aorta and its major branches. Hepatic \narterial anatomy is conventional. Assessment of the venous \nvasculature is limited by the timing of contrast. \n \nCTA LOWER EXTREMITIES: \n \nOn the right, there is an unchanged ectasia of the common \nfemoral artery \nmeasuring 1.8 x 1.7 cm (3a:150) at the graft anastamosis. There \nis complete occlusion of the right superficial femoral artery \nwhich contains a stent graft extending to the level of the \npopliteal artery. There is reconstitution of the popliteal \nartery through collaterals from the deep femoral artery, with \ndiminished caliber. A three-vessel runoff is demonstrated \nproximally, but there is severe attenution of the anterior \ntibial, posterior tibial, and peroneal arteries until the distal \nthird of the lower leg where the peroneal artery and posterior \ntibial artery are no longer opacified. The dorsalis pedis is \ndiminutive. There has been prior amputation of the right \nforefoot. \n \nOn the left are two grafts extending from the common femoral \nartery, both of which are occluded, one within the superficial \nfemoral artery terminating in the distal medial thigh, and a \nfemoral-to-anterior tibial artery bypass. The bypass graft \ndemonstrates two insertions into the anterior tibial artery \n(3a:334, 390), with both limbs completely occluded. There is \nmild stenosis at the graft insertion site of the left common \nfemoral artery. There is reconstitution of the popliteal \nartery, which is diminutive, via collaterals from the deep \nfemoral artery. A three-vessel runoff is demonstrated with \nmoderate attention of the anterior tibial, peroneal and \nposterior tibial arteries until the mid lower leg, where the \nanterior tibial artery is partially obscured by the lower \nportion of the femoral-AT bypass. The posterior tibial artery is \nopacified throughout its course mild irregular attenuation along \nthe distal portion. The peroneal artery is opacified to the \nlevel of the ankle joint. The dorsalis pedis artery is patent. \n \nABDOMEN: \n \nEvaluation is limited by the arterial phase of image \nacquisition. The liver is steatotic with no concerning focal \nlesion. The gallbladder and biliary tree are normal. In the \npancreas, there is an unchanged 7 mm hypodense lesion that may \nrepresent an IPMN (03:31). The spleen is normal in size, without \nfocal lesion. The adrenal glands are normal. In the kidneys, \nthere unchangedright upper pole renal cyst and another 2 left \nrenal hypo enhancing lesions that may also represent cysts \n(3a:24, 3a:34, 3a:68). There may be a small duodenum \ndiverticulum involving the second stage of the duodenum ( \n3a:51). There is colonic diverticulosis. The small bowel and \nlarge bowel are normal in caliber, without wall thickening or \nmass. There is no intra- or retroperitoneal lymphadenopathy. \nThere is no ascites, fluid collection, or pneumoperitoneum. \n \nPELVIS: \n \n The urinary bladder is without wall thickening or mass. The \nrectum is \nunremarkable. The prostate gland is mildly enlarged with coarse \ncalcifications. There is no free fluid. There is no pelvic or \ninguinal \nlymphadenopathy. \n \nBONES AND SOFT TISSUES: \n \nThere are degenerative changes within the lumbosacral spine with \nno fracture. \nThere are no destructive osseous lesions concerning for \nmalignancy or \ninfection. There are no soft tissue masses. \n \nIMPRESSION: \n \n1. Complete occlusion of bilateral superficial femoral arteries \nand left \nfemoral to anterior tibial grafts, with popliteal reconstitution \nfrom the deep femoral collaterals. \n2. Moderate attention of the left anterior tibial, peroneal and \nposterior tibial arteries, appearing patent to the level of the \nankles. Patent dorsalis pedis. \n3. Severe attenuation of the right peroneal and posterior \ntibial arteries with no appreciable flow beyond the distal third \nsegment. Severe attenuation of the right anterior tibial artery \nwith flow extending to the dorsalis pedis \nartery. Post right forefoot amputation. \n4. Patent bilateral iliac stents with mild to moderate stenosis \nas described above. \n5. Likely 7 mm side-branch IPMN in the pancreatic body remains \nstable and can be followed in ___ years to ensure stability.\nThe patient was admitted to the hospital with claudication. His \npain was controlled with po pain medication that he was on while \nat home. He underwent arterial studies that showed severly \ndecreased flow to his lower left extremity. He underwent a CTA \nthat showed a possible new lesion in the profunda artery. He was \nstable and he was scheduled to return as an outpatient for an \nangiogram and possible angioplasty to try to improve his \nclaudication. \n\nDue to concerns over not taking his home medications it was \narranged that his home medications were delivered to him prior \nto his discharge.'}}
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{'final_diagnoses': ['Claudication'], 'procedures': ['none'], 'visit_summary': 'The patient was admitted to the hospital with claudication. His \npain was controlled with po pain medication that he was on while \nat home. He underwent arterial studies that showed severly \ndecreased flow to his lower left extremity. He underwent a CTA \nthat showed a possible new lesion in the profunda artery. He was \nstable and he was scheduled to return as an outpatient for an \nangiogram and possible angioplasty to try to improve his \nclaudication. \n\nDue to concerns over not taking his home medications it was \narranged that his home medications were delivered to him prior \nto his discharge.', 'medications_prescribed': ['OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth six hours Disp #*50 \nTablet Refills:*0', 'Acetaminophen 325-650 mg PO Q6H:PRN pain \nRX *acetaminophen 325 mg ___ tablet(s) by mouth every 6 hours \nDisp #*30 Tablet Refills:*0', 'Aspirin 325 mg PO DAILY \nRX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*30 Capsule Refills:*0', 'Metoprolol Tartrate 25 mg PO BID \nRX *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*0', 'Senna 8.6 mg PO BID \nRX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day \nDisp #*30 Capsule Refills:*0', 'Atorvastatin 40 mg PO HS \nRX *atorvastatin 40 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'Lorazepam 1 mg PO HS:PRN sleep \nRX *lorazepam 1 mg 1 tablet by mouth daily Disp #*14 Tablet \nRefills:*0', 'MetFORMIN (Glucophage) 500 mg PO BID \nRX *metformin 500 mg 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 76, 'gender': 'M', 'symptoms': 'Chest & bilateral arm pain', 'medical_history': ['Actinic Keratosis', 'ADHD', 'Anxiety', 'Carpal tunnel ', 'Depression', 'Diabetes Mellitus Type II', "Dupuytren's Contracture left hand > right hand ", 'Hyperlipidemia ', 'Hypertension', 'Hypothyroid'], 'family_history': 'Mother had heart surgery at ___ years of age \nFather died at age ___ of myocardial infarction\nDaughter deceased at age ___ of cancer \nBrother history of CAD stents at age ___\nBrother CAD s/p CABG in his ___ ', 'present_illness': 'Mrs. ___ is a ___ year old woman with a history of \ndiabetes mellitus, hyperlipidemia, and hypertension. She \npresented to ___ with a two day history of intermittent \nchest pain with associated bilateral arm pain. Her symptoms \nimproved with nitroglycerin and Heparin drip. She was \ntransferred to ___ for cardiac catheterization. The study \nrevealed two vessel coronary artery disease. Cardiac surgery was \nconsulted for surgical revascularization.', 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DOPamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Guaifenesin ER', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin A', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Alteplase 1mg/2mL ( Clearance ie. PICC, tunneled access line )', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ascorbic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Psyllium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zinc Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Collagenase Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 438.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.9,. Estimated GFR = 35 if non African-American (mL/min/1.73 m2). Estimated GFR = 42 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 196.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '378', 'valuenum': 378.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.96, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75.1', 'valuenum': 75.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '369', 'valuenum': 369.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '616', 'valuenum': 616.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.16', 'valuenum': 1.16, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 37.6, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '97.6AX.'}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': 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4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '70.3', 'valuenum': 70.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96.1', 'valuenum': 96.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '338', 'valuenum': 338.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '376', 'valuenum': 376.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98.4', 'valuenum': 98.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.2,. Estimated GFR = 29 if non African-American (mL/min/1.73 m2). Estimated GFR = 35 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '363', 'valuenum': 363.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '75.7', 'valuenum': 75.7, 'valueuom': 'sec', 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{'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 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'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98.8', 'valuenum': 98.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 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'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '>182*.'}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse:86 Resp: 18 O2 sat: 99%RA\nB/P ___\nHeight: 5\'4" Weight:152\n\nGeneral: no acute distress\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] EOMI [x]\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Murmur none \nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds \n+ [x]\nExtremities: Warm [x], well-perfused [x] Edema trace\nVaricosities: None [x]\nNeuro: Grossly intact [x] except baseline contracture of fingers \nleft ___ digits and right ___ digits noteable at rest \nPulses:\nFemoral Right: +2 Left: +2\nDP Right: +1 Left: +1\n___ Right: +1 Left: +1\nRadial Right: +2 Left: +2\n\nCarotid Bruit: Right: + bruit Left: no bruit \n.\n98.0\nPO 131 / 59 89 20 96 Ra \nGeneral/Neuro: NAD [x] A/O x3 [x] non-focal [x] \nCardiac: RRR [x] Irregular [] Nl S1 S2 []\nLungs: CTA [x] No resp distress [x] Dim bases\nAbd: NBS [x]Soft [x] ND [x] NT [x]\nExtremities: no CCE[x] Pulses doppler [] palpable [x] Trace\nedema \nWounds: Sternal: CDI [x] no erythema or drainage [x]\n Sternum stable [x] Prevena [x]', 'diagnoses': [{'icd_code': '4260', 'desc': 'Atrioventricular block, complete'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '42823', 'desc': 'Acute on chronic systolic heart failure'}, {'icd_code': '70703', 'desc': 'Pressure ulcer, lower back'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '3441', 'desc': 'Paraplegia'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '70723', 'desc': 'Pressure ulcer, stage III'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '73018', 'desc': 'Chronic osteomyelitis, other specified sites'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': '4148', 'desc': 'Other specified forms of chronic ischemic heart disease'}, {'icd_code': 'V462'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '42682', 'desc': 'Long QT syndrome'}, {'icd_code': '04109', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus'}, {'icd_code': 'V4987', 'desc': 'Physical restraints status'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '70707', 'desc': 'Pressure ulcer, heel'}], 'summary': 'Cardiac Catheterization ___\nDominance: Right\nLMCA: without significant disease.\nLAD: eccentric 60% proximal disease, and mid 50%. ___ Diagonal \nwithout significant disease.\nLCX: without significant disease.\nRCA: 90% mid stenosis. Right PDA without significant disease.\n\nTransthoracic Echocardiogram ___\nThe left atrial volume index is normal. Left ventricular wall \nthicknesses are normal. The left ventricular cavity size is \nnormal. Overall left ventricular systolic function is low normal \n(LVEF = 50%) secondary to hypokinesis of the inferior and \nposterior walls. Right ventricular chamber size and free wall \nmotion are normal. The diameters of aorta at the sinus, \nascending and arch levels are normal. The aortic valve leaflets \n(3) are mildly thickened but aortic stenosis is not present. No \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. Trivial mitral regurgitation is seen. The \nestimated pulmonary artery systolic pressure is normal. There is \nno pericardial effusion. \n.\n\n___ 04:28AM BLOOD WBC-9.2 RBC-3.14* Hgb-9.1* Hct-28.4* \nMCV-90 MCH-29.0 MCHC-32.0 RDW-14.4 RDWSD-47.0* Plt ___\n___ 01:52PM BLOOD WBC-14.6* RBC-3.63* Hgb-10.4* Hct-31.2* \nMCV-86 MCH-28.7 MCHC-33.3 RDW-13.7 RDWSD-42.5 Plt ___\n___ 01:52PM BLOOD ___ PTT-30.6 ___\n___ 04:42AM BLOOD UreaN-20 Creat-0.8 K-4.6\n___ 04:25AM BLOOD Glucose-156* UreaN-17 Creat-0.9 Na-138 \nK-4.6 Cl-102 HCO3-24 AnGap-12\n___ 04:42AM BLOOD Mg-1.9\nShe was admitted on ___ for cardiac catheterization which \ndemonstrated 2 vessel coronary artery disease. Cardiac surgery \nwas consulted and she underwent routine preoperative testing and \nevaluation. She remained hemodynamically stable and was taken to \nthe operating room on ___. She underwent coronary artery \nbypass grafting x2. Please see operative note for full details. \nPrevena placed to optimize wound healing. She tolerated the \nprocedure well and was transferred to the CVICU in stable \ncondition for recovery and invasive monitoring. \n \nShe weaned from sedation, awoke neurologically intact and was \nextubated later that day. Beta blocker was initiated and she was \ndiuresed toward her preoperative weight. She remained \nhemodynamically stable and was transferred to the telemetry \nfloor for further recovery. She was evaluated by the physical \ntherapy service for assistance with strength and mobility. By \nthe time of discharge on POD 5 she was ambulating freely, the \nwound was healing, and pain was controlled with oral analgesics. \nShe was discharged home in good condition with appropriate \nfollow up instructions.'}}
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{'final_diagnoses': ['Coronary Artery Disease ', 'Actinic Keratosis ', 'ADHD ', 'Anxiety ', 'Carpal tunnel ', 'Depression ', 'Diabetes Mellitus Type II ', "Dupuytren's Contracture left hand > right hand ", 'Hyperlipidemia ', 'Hypertension ', 'Hypothyroid'], 'procedures': ['___ - Coronary artery bypass grafts x2 (LIMA-LAD, \nSVG-PDA); Endovascular saphenous vein harvest RLE; Epiaortic \nultrasound'], 'visit_summary': 'She was admitted on ___ for cardiac catheterization which \ndemonstrated 2 vessel coronary artery disease. Cardiac surgery \nwas consulted and she underwent routine preoperative testing and \nevaluation. She remained hemodynamically stable and was taken to \nthe operating room on ___. She underwent coronary artery \nbypass grafting x2. Please see operative note for full details. \nPrevena placed to optimize wound healing. She tolerated the \nprocedure well and was transferred to the CVICU in stable \ncondition for recovery and invasive monitoring. \n \nShe weaned from sedation, awoke neurologically intact and was \nextubated later that day. Beta blocker was initiated and she was \ndiuresed toward her preoperative weight. She remained \nhemodynamically stable and was transferred to the telemetry \nfloor for further recovery. She was evaluated by the physical \ntherapy service for assistance with strength and mobility. By \nthe time of discharge on POD 5 she was ambulating freely, the \nwound was healing, and pain was controlled with oral analgesics. \nShe was discharged home in good condition with appropriate \nfollow up instructions.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild ', 'Atorvastatin 40 mg PO QPM \nRX *atorvastatin 40 mg 1 tablet(s) by mouth qpm Disp #*30 Tablet \nRefills:*1 ', 'Furosemide 40 mg PO DAILY Duration: 10 Days \nRX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*10 Tablet \nRefills:*1 ', 'Metoprolol Tartrate 75 mg PO TID \nRX *metoprolol tartrate 75 mg 1 tablet(s) by mouth three times a \nday Disp #*90 Tablet Refills:*1 ', 'Potassium Chloride 20 mEq PO DAILY Duration: 10 Days \nRX *potassium chloride 20 mEq 1 tablet(s) by mouth daily Disp \n#*10 Tablet Refills:*1 ', 'Ranitidine 75 mg PO DAILY \nRX *ranitidine HCl 75 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0 ', 'Amphetamine-Dextroamphetamine XR 50 mg PO DAILY ', 'Aspirin 81 mg PO DAILY ', 'Levothyroxine Sodium 25 mcg PO DAILY ', 'MetFORMIN (Glucophage) 500 mg PO QPM ', 'Multivitamins 1 TAB PO DAILY ', 'Ocuvite (vit C-vit E-lutein-min-om-3) 150-30-5-150 \nmg-unit-mg-mg oral DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 63, 'gender': 'F', 'symptoms': 'seizure', 'medical_history': ['-Subdural hemorrhages - unclear etiology, occurrence in ___ and \n___', '-Acute necrotizing pancreatitis', '-HTN ', '-HLD ', '-paroxysmal afib ', '-subdural hematoma while on ASA and Plavix, ___ (Plavis was \ndiscontinued; was only on plavix for 1 month) ', '-SDH seen on imaging in ___, ASA discontinued ', '-CAD - per cardiology note in OMR: "CAD s/p MI ___ ___: \nmLAD 40%, mRCA30%)" ', '-DM2 ', '-?Cirrhosis ', '-L knee injury and repair (child) ', '-R knee replacement ', '-R Achilles tendon repair - ___, ruptured in the setting of \ntrying push his car when it ran out of fuel ', '-Right rotator cuff repair ', '- Planned for L rotator cuff repair'], 'family_history': 'Father with coronary artery disease s/p 4v CABG and 100% \noccluded L CEA with recurrent CVAs \nMother lived to ___, diagnosed with colon ca at ___, s/p colonic \nsurgery. ', 'present_illness': 'The pt is a ___ right-handed man with HTN, HLD, DM, and\nleft frontal subdural with recent admissions to ___ for\ntransient RUE movements with previous negative stroke workup\nfelt to be likely due to seizure despite negative EEG on\nLevetiracetam who was BIB ambulance after he developed confusion \nand word finding difficulties.\n\nAs per report, pt has had two recent admissions to ___ for\nworkup of these right-sided movements, first admitted to the\nStroke Service ___ with negative MRI and stroke workup,\nbut found to have persistent left SDH (initially noted in\n___ thus the events were felt to be\nsecondary to seizure possibly secondary to mass effect from L\nSDH. He represented to ___ on ___ with recurrence, at \nwhich time he was admitted and underwent EEG monitoring which \nwas notable for focal intermittent\nslowing in the left frontotemporal and frontocentral regions\nsuggestive of decreased seizure threshold, but ___ actual\nseizures. He was discharged home on Levetiracetam 1000mg BID.\n\nAs per report from his wife, ___ has been in his usual state \nof\nhealth. He only received half of his dose of insulin on \n___ due to running out of the medication, but ___ missed doses\nof Levetiracetam. Wife denies any recent illnesses, fever,\ncough, nasal congestion vomiting or diarrhea. He did have some\ndiarrhea ___ ago but it was felt to be secondary to one of \nhis\nDM medicines (Invocana) and the diarrhea has resolved since\ndiscontinuation of the medication. ___ known falls.\n\nMrs. ___ reports that ___ called her this morning after he\nstarted to have right-sided movements that start with the R \nthumb and then progress to involve each of the fingers of his \nright hand without involvement of the wrist or arm. Ha also \nendorsed tingling of his lip\nand his right arm. He checked his D-stick which was 400, so she\ninstructed him to call EMS and be brought to the ED.\n\nUpon arrival to the ED, he was hypertensive 174/97 which \nresolved\non its own with ___ medications. Dstick on arrival was 440. He\nwas noted to have RUE weakness with ___ut\nwas oriented and appropriately answered questions. While in the\nED, the pt was confused and had word finding difficulties and \nfound to have RUE mild weakness. Neurology was consulted. NCHCT \nwas performed in\nthe ED and showed stable L SDH with ___ mass effect, ___ acute\nhemorrhage.', 'medications': [{'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Acyclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51.3', 'valuenum': 51.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '169', 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'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\n\nGeneral: awake, cooperative, NAD.\nHEENT: NC/AT, ___ scleral icterus noted, MMM, ___ lesions noted in\noropharynx\nNeck: supple, ___ nuchal rigidity\nPulmonary: breathing comfortably on room air\nCardiac: RRR on EKG\nAbdomen: soft, NT/ND\nExtremities: warm, well perfused\nSkin: ___ rashes or lesions noted\n\nNeurologic:\nMental Status: Alert, able to state name initially, but then not\nable to say any other words except "yea". Upset/frustrated by\nlack of ability to express himself\nCranial Nerves:\nPERRL 2-->1. EOMI without nystagmus. Normal saccades. VFF to\nconfrontation.VII: LNLFF at rest and left-sided asymmetry with\nsmile. Tongue midline\nMotor: Normal bulk, tone throughout. Non-suppressible Rhythmic\nmovement of right hand noted.\n Delt Bic Tri IP Quad Ham \nL 5 ___ 5 5 \nR 4 ___ 5 5 \n\nSensory: moves all extremtiies to noxious.\n\nDTRs:\n Bi ___ Pat \nL 2 2 2 \nR 2 2 2 \n\nCoord/Gait: not appropriate for pt status\n\n======================\n\nDISCHARGE EXAM:\n\nGen: awake, conversant pt, comfortable and cooperative\nResp: ___ incr WOB\nCV: WWP\nAbd: nondistended\nExtr: spontaneous movement\nSkin: ___ obvious rash or lesions\n\nNeurologic Exam:\nMS:\n-Awake, alert, and oriented to person, date, and place.\n-Attention intact\n-Naming intact\n-Repetition intact\n-Calculation intact\nCN:\n-Pupillary light reflex 4->3 b/l\n-___ double vision or nystagmus\n-Fields of vision intact to confrontation\n-Nasolabial flattening on the R, symmetric activation\nMotor:\n-Pronation of L arm (chronic pain limited) without drift\n R L\nDelt 5 5\nBi 5 5\nTri 5 ___\nFF 5 ___\nFE 5 5\nWrFlex 5 5\nWrExt 5- 5 \n\nReflexes: deferred\nCoord: Finger tapping slower on the L side (patient R-handed).\nGait: ___ ataxia', 'diagnoses': [{'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5722', 'desc': 'Hepatic encephalopathy'}, {'icd_code': '20500', 'desc': 'Acute myeloid leukemia, without mention of having achieved remission'}, {'icd_code': '5119', 'desc': 'Unspecified pleural effusion'}, {'icd_code': '514', 'desc': 'Pulmonary congestion and hypostasis'}, {'icd_code': 'V4282', 'desc': 'Peripheral stem cells replaced by transplant'}, {'icd_code': '5723', 'desc': 'Portal hypertension'}, {'icd_code': '27900', 'desc': 'Hypogammaglobulinemia, unspecified'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '27503', 'desc': 'Other hemochromatosis'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': 'V4571', 'desc': 'Acquired absence of breast and nipple'}, {'icd_code': 'V103'}, {'icd_code': 'V153'}, {'icd_code': 'V1083', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'V1253', 'desc': 'Personal history of sudden cardiac arrest'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': 'V8801', 'desc': 'Acquired absence of both cervix and uterus'}, {'icd_code': 'V433'}, {'icd_code': '27542', 'desc': 'Hypercalcemia'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '27669', 'desc': 'Other fluid overload'}], 'summary': 'Laboratory Studies:\n\n___ 05:25AM BLOOD WBC-6.2 RBC-4.26* Hgb-12.7* Hct-38.9* \nMCV-91 MCH-29.8 MCHC-32.6 RDW-13.2 RDWSD-44.1 Plt ___\n___ 05:25AM BLOOD Plt ___\n___ 03:25PM BLOOD ___ PTT-26.0 ___\n___ 05:25AM BLOOD Glucose-241* UreaN-19 Creat-0.8 Na-139 \nK-4.3 Cl-102 HCO3-26 AnGap-11\n___ 10:59AM BLOOD ALT-17 AST-17 AlkPhos-97 TotBili-0.5\n___ 03:25PM BLOOD D-Dimer-1085*\n___ 09:04AM BLOOD %HbA1c-10.0* eAG-240*\n___ 10:59AM BLOOD TSH-0.53\n___ 10:59AM BLOOD Free T4-1.2\n\n-----------\nDIAGNOSTIC STUDIES:\n\nMRI Brain ___:\n1. New, small left parietal subarachnoid hemorrhage. \n2. Bilateral small subdurals extending from frontal to occipital \nregions with \ndiffuse pachymeningeal enhancement has slightly increased from \nthe previous \nMRI study. \n3. Diffuse pachymeningeal enhancement, may be reactive to the \nunderlying \nsubdural hematomas or secondary to intracranial hypotension from \nCSF leak, if \nthe patient has a history of trauma or lumbar puncture. \nInfection or \ninflammation is possible but less likely. Given the symmetry \nand lack of \nbony involvement, neoplastic meningeal disease is considered to \nbe much less \nlikely. \n\nCT Head ___:\nUnchanged, small left frontal subacute to chronic subdural \nhematoma with \nminimal adjacent mass effect. ___ evidence of new acute \nhemorrhage or \nintracranial abnormality. \n\nCTA Head & Neck:\n1. Equivocal hyperdensity in the left high frontoparietal sulci, \nwhich may\ncorrelate with areas of FLAIR hyperintensity on recent MR. ___ \nareas for\ndefinite new acute intracranial hemorrhage.\n2. Late acute chronic appearing bilateral cerebral convexity \nsubdural\nhematomas are unchanged.\n3. Chronic inferior left paramedian frontal lobe \nencephalomalacia versus\nvolume loss.\n4. Mild atherosclerotic disease with patent intracranial and \ncervical\nvasculature. ___ high-grade stenosis, occlusion, or aneurysm is \ndetected.\n \n\nEEG (preliminary): ___ seizures or epileptic discharges.\nSummary: Mr. ___ is a ___ right-handed male with HTN, \nHLD, DM, hx prior subdural hemorrhages in ___ and ___, with \nleft frontal subdural again noted ___, presents with \nrecurrent abnormal movements of the R hand, confusion, and \naphasia. In the ED, he was given 2mg Ativan and 1000mg Keppra IV \nwith resolution of symptoms. He was found to have chronic \nbilateral subdural hemorrhages and small left parietal \nhemorrhage (not acute). He was discharged after AED titration, \nand will follow up with neurology.\n\nNeurology Floor Course:\n\nThe abnormal movements were described as sterotyped with slow \nprogression of motor involvement of the R thumb, and subsequent \ninvolvement of R fingers spreading over ___ minutes and would \nlast up to 9 minutes. He had multiple prior episodes for which \nhe had been evaluated in the ED, and had been started on Keppra \n1000mg BID in ___. He had not had aphasia and confusion \nuntil this presentation. The slow progression of motor symptoms \nwas felt to be consistent with spreading cortical depression vs \nseizure, given symptoms of aphasia and altered mental status \nthis admission.\n\nPrior EEG had shown left sided slowing. EEG was done this \nadmission, without epileptiform discharges. OXcarbazepine 300mg \nBID was added to his AED regimen, with plan to uptitrate as an \noutpatient. He did not have any further seizures during \nadmission.\n\nCT done in the ED was unremarkable. MRI w/wo contrast was \nobtained upon admission and showed new small L parietal \nsubarachnoid hemorrhage, and progressive subdural hemorrhages \nthat were bilateral (in ___, ___ was noted to be L sided \nonly). Neurosurgery was consulted to help with workup of \netiology and recommended CTA which was negative. He was found to \nhave a mild thrombocytopenia, but otherwise had normal ___. \nDue to concern for etiology of CAA, lumbar puncture was \nperformed on ___ which showed mildly elevated protein 103 (may \nbe attributed to diabetes or chronic subdural) and A beta and \ntau protein were pending.\n\n___ was consulted during admission. His \ndiabetic regimen was changed to Lantus and SS insulin during \ninsulin, and returned to home regimen upon discharge. Metformin \nwas held due to IV contrast received on ___. It can be \nrestarted on ___.'}}
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{'final_diagnoses': ['Seizure', 'Subdural hemorrhage', 'Subarachnoid hemorrhage'], 'procedures': ['None'], 'visit_summary': 'Summary: Mr. ___ is a ___ right-handed male with HTN, \nHLD, DM, hx prior subdural hemorrhages in ___ and ___, with \nleft frontal subdural again noted ___, presents with \nrecurrent abnormal movements of the R hand, confusion, and \naphasia. In the ED, he was given 2mg Ativan and 1000mg Keppra IV \nwith resolution of symptoms. He was found to have chronic \nbilateral subdural hemorrhages and small left parietal \nhemorrhage (not acute). He was discharged after AED titration, \nand will follow up with neurology.\n\nNeurology Floor Course:\n\nThe abnormal movements were described as sterotyped with slow \nprogression of motor involvement of the R thumb, and subsequent \ninvolvement of R fingers spreading over ___ minutes and would \nlast up to 9 minutes. He had multiple prior episodes for which \nhe had been evaluated in the ED, and had been started on Keppra \n1000mg BID in ___. He had not had aphasia and confusion \nuntil this presentation. The slow progression of motor symptoms \nwas felt to be consistent with spreading cortical depression vs \nseizure, given symptoms of aphasia and altered mental status \nthis admission.\n\nPrior EEG had shown left sided slowing. EEG was done this \nadmission, without epileptiform discharges. OXcarbazepine 300mg \nBID was added to his AED regimen, with plan to uptitrate as an \noutpatient. He did not have any further seizures during \nadmission.\n\nCT done in the ED was unremarkable. MRI w/wo contrast was \nobtained upon admission and showed new small L parietal \nsubarachnoid hemorrhage, and progressive subdural hemorrhages \nthat were bilateral (in ___, ___ was noted to be L sided \nonly). Neurosurgery was consulted to help with workup of \netiology and recommended CTA which was negative. He was found to \nhave a mild thrombocytopenia, but otherwise had normal ___. \nDue to concern for etiology of CAA, lumbar puncture was \nperformed on ___ which showed mildly elevated protein 103 (may \nbe attributed to diabetes or chronic subdural) and A beta and \ntau protein were pending.\n\n___ was consulted during admission. His \ndiabetic regimen was changed to Lantus and SS insulin during \ninsulin, and returned to home regimen upon discharge. Metformin \nwas held due to IV contrast received on ___. It can be \nrestarted on ___.', 'medications_prescribed': ['1. OXcarbazepine 300 mg PO BID \nRX *oxcarbazepine 300 mg 1 tablet(s) by mouth twice daily Disp \n#*60 Tablet Refills:*5 ', '2. Atorvastatin 40 mg PO QPM ', '3. GlyBURIDE 5 mg PO BID ', '4. LevETIRAcetam 1000 mg PO BID ', '5. Metoprolol Succinate XL 50 mg PO DAILY ', '6. Omeprazole 40 mg PO DAILY ', '7. Tresiba FlexTouch U-100 (insulin degludec) 8 Units \nsubcutaneous DAILY ', '8. HELD- MetFORMIN (Glucophage) 1000 mg PO BID This medication \nwas held. Do not restart MetFORMIN (Glucophage) until ___ \n___ (since you received IV contrast this week)']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'F', 'symptoms': 'rash', 'medical_history': ['HCV', 'DJD', 'Eczema'], 'family_history': 'Maternal Grandmother w/MS', 'present_illness': '___ w/HCV, eczema presemts with painful rash on her chest for 2 \nweeks. Pt first seen in ED on ___, diagnosed with \ncellulitis/erysiplas and started on keflex. Pt return on ___ \nwith worsening rash, changed to clinda and told to stop topical \nsteroids. She does see a dermatologist for eczema but has been \nunable to see them about this and this is different from prior \nrashes. No fevers, travel or new skin products. No lesions \ninside the mouth or groin or palms or soles. Does report that \nher cat will lay on her chest and she gets frequent scratches. \nPt transferred from OSH ED for derm eval.\n\nIn ED pt given vancomycin and azithromycin.\nOn arrival to the floor pt reports rash is still very painful.\n\nROS: +as above, otherwise reviewed and negative', 'medications': [{'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ascorbic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TD', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'MRX1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Doxepin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Doxepin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 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'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 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'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '365', 'valuenum': 365.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.00', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.50', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '338', 'valuenum': 338.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.01', 'valuenum': 1.01, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '182', 'valuenum': 182.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '418', 'valuenum': 418.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '4.40', 'valuenum': 4.4, 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'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59.8', 'valuenum': 59.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 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'7.14', 'valuenum': 7.14, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '44.6', 'valuenum': 44.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 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'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '397', 'valuenum': 397.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 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'priority': 'STAT', 'comments': None}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '367', 'valuenum': 367.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-5', 'valuenum': -5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 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'6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 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'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.53', 'valuenum': 7.53, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.12', 'valuenum': 3.12, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.9', 'valuenum': 47.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.24', 'valuenum': 3.24, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.2', 'valuenum': 48.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: T:97.9 BP:176/104 P:71 R:18 O2:100%ra \nPAIN: 10\nGeneral: nad\nLungs: clear\nCV: rrr no m/r/g\nAbdomen: bowel sounds present, soft, nt/nd\nExt: no e/c/c\nSkin: rash on chest, anterior neck confluent reddness with skin \npeeling and scabbing\nNeuro: alert, follows commands', 'diagnoses': [{'icd_code': 'Q231', 'desc': 'Congenital insufficiency of aortic valve'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'I5030', 'desc': 'Unspecified diastolic (congestive) heart failure'}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'F410', 'desc': 'Panic disorder [episodic paroxysmal anxiety]'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I341', 'desc': 'Nonrheumatic mitral (valve) prolapse'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}], 'summary': '___ 11:20PM GLUCOSE-124* UREA N-19 CREAT-0.8 SODIUM-130* \nPOTASSIUM-8.1* CHLORIDE-96 TOTAL CO2-26 ANION GAP-16\n___ 11:20PM ALT(SGPT)-291* AST(SGOT)-415* ALK PHOS-84 TOT \nBILI-1.0\n___ 11:20PM ALBUMIN-4.1\n___ 11:20PM WBC-4.3 RBC-4.26 HGB-14.7 HCT-41.6 MCV-98 \nMCH-34.5* MCHC-35.3* RDW-13.2\n___ 11:20PM NEUTS-45.3* ___ MONOS-11.6* EOS-2.4 \nBASOS-1.7\n___ 11:20PM PLT COUNT-104*\nASSESSMENT AND PLAN: ___ w/HCV, eczema presemts with painful \nrash on her chest for 2 weeks. \n\nDermatology was consulted. \n\nThey felt that this was most likely a reaction from applying \nefudex to the area, but could not rule out herpes. \n\nTheir recommendations were:\n-no indication for IV abx - can use topical mupirocin BID in\nareas with yellow-brown crust\n-start PO acyclovir 400 mg TID x 5 days\n-pain mgmt per primary team\n-can use zyrtec 10 mg daily and/or benadryl q6h PRN for itch,\ncaution sedation side effect\n-f/u next week with outpatient\ndermatologist NP ___ (___) who is aware of her\nadmission\n\nHypertension: no prior history, likely ___ pain\n- pain control\n- CTM\n\nHCV: no prior treatment. Transaminitis unchanged from CHA \nrecords.\n\nThe patient was discharged to home in stable condition.'}}
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{'final_diagnoses': ['possible Eczema herpeticum or possible reaction to Efudex.'], 'procedures': ['none'], 'visit_summary': 'ASSESSMENT AND PLAN: ___ w/HCV, eczema presemts with painful \nrash on her chest for 2 weeks. \n\nDermatology was consulted. \n\nThey felt that this was most likely a reaction from applying \nefudex to the area, but could not rule out herpes. \n\nTheir recommendations were:\n-no indication for IV abx - can use topical mupirocin BID in\nareas with yellow-brown crust\n-start PO acyclovir 400 mg TID x 5 days\n-pain mgmt per primary team\n-can use zyrtec 10 mg daily and/or benadryl q6h PRN for itch,\ncaution sedation side effect\n-f/u next week with outpatient\ndermatologist NP ___ (___) who is aware of her\nadmission\n\nHypertension: no prior history, likely ___ pain\n- pain control\n- CTM\n\nHCV: no prior treatment. Transaminitis unchanged from CHA \nrecords.\n\nThe patient was discharged to home in stable condition.', 'medications_prescribed': ['Naproxen 500 mg PO Q8H:PRN pain', 'Acyclovir 400 mg PO TID', 'Mupirocin Ointment 2% 1 Appl TP BID \nto brown crust areas of the rash \nRX *mupirocin 2 % apply to brown crusts on rash twice a day \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 82, 'gender': 'F', 'symptoms': 'Hypertension, chest pain', 'medical_history': ['HTN', 'Mitral Prolapse/Mitral Regurg s/p mitral valve repair'], 'family_history': 'Non-contributory', 'present_illness': "___ y/o ___ speaking woman with h/o HTN and s/p mitral valve \nrepair for mitral prolapse and MR, presented to ED with \nheadache, chest pain, and hypertension. She checks her BP at \nhome and the night prior to presentation had a SBP in the 200s; \nshe reportedly took extra hypertension medications including \nclonidine, atenolol, altase (ACE-I) and went to bed. \nBP was still in the 200s later on and she took more BP meds \n(extra clonidine and ACEI, ?atenolol. She then came to ED with \nHA and chest pressure. \nBP on presentation was 137/111 by EMS, 204/110 in ED on \npresentation, 170's in ED, and came down to 156/92. She was in \nsinus bradycardia with HR 56, satting well on RA. CXR was normal \nper ED read. ECG showed no changes, only sinus brady. ___ set \nof cardiac enzymes was negative. In the ED she received ASA and \nshe was admitted for ___ (for chest pain). \n.", 'medications': [{'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bumetanide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bumetanide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin (Impella)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IMPELLA', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DOPamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin (Impella)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IMPELLA', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.28, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '264', 'valuenum': 264.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 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'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 671.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPECIMEN SLIGHTLY HEMOLYZED..'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.3', 'valuenum': 87.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '273', 'valuenum': 273.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.2', 'valuenum': 45.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '651', 'valuenum': 651.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '602', 'valuenum': 602.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '479', 'valuenum': 479.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '791', 'valuenum': 791.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.87, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '246', 'valuenum': 246.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90.4', 'valuenum': 90.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '221', 'valuenum': 221.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 102.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 120.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.39', 'valuenum': 3.39, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '589', 'valuenum': 589.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '222', 'valuenum': 222.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.3,. Estimated GFR = 20 if non African-American (mL/min/1.73 m2). Estimated GFR = 25 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '894', 'valuenum': 894.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.33, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '95.9', 'valuenum': 95.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.7', 'valuenum': 43.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.99, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '56.5', 'valuenum': 56.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89.5', 'valuenum': 89.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '85.5', 'valuenum': 85.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.020', 'valuenum': 1.02, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86.9', 'valuenum': 86.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79.7', 'valuenum': 79.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mg/dL', 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'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '462', 'valuenum': 462.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.3', 'valuenum': 49.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50.8', 'valuenum': 50.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '256', 'valuenum': 256.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.1', 'valuenum': 52.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.5,. Estimated GFR = 33 if non African-American (mL/min/1.73 m2). Estimated GFR = 40 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 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{'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 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'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.3', 'valuenum': 52.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T:98.2 BP:140/70 HR:57 RR:18 o2:966/RA\nHEENT: no JVD, MMM\nHeart:RRR, no M/R/G, nl s1 s2\nLungs:CTABL\nAbdomen:soft, NT ND no HSM BS +\nExt:no edema\nNeuro:AAO x 3, CN II-XII intact, no focal mottor or sensory \ndeficit', 'diagnoses': [{'icd_code': 'I214', 'desc': 'Non-ST elevation (NSTEMI) myocardial infarction'}, {'icd_code': 'R570', 'desc': 'Cardiogenic shock'}, {'icd_code': 'I5023', 'desc': 'Acute on chronic systolic (congestive) heart failure'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'I97610', 'desc': 'Postprocedural hemorrhage of a circulatory system organ or structure following a cardiac catheterization'}, {'icd_code': 'T82528A', 'desc': 'Displacement of other cardiac and vascular devices and implants, initial encounter'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'I083', 'desc': 'Combined rheumatic disorders of mitral, aortic and tricuspid valves'}, {'icd_code': 'I2584', 'desc': 'Coronary atherosclerosis due to calcified coronary lesion'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'R740', 'desc': 'Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'T508X5A', 'desc': 'Adverse effect of diagnostic agents, initial encounter'}, {'icd_code': 'Y840', 'desc': 'Cardiac catheterization as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'R5383', 'desc': 'Other fatigue'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'N141', 'desc': 'Nephropathy induced by other drugs, medicaments and biological substances'}, {'icd_code': 'Y848', 'desc': 'Other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}], 'summary': "___ 06:45AM BLOOD WBC-5.2 RBC-4.07* Hgb-12.4 Hct-35.4* \nMCV-87 MCH-30.4 MCHC-34.9 RDW-13.8 Plt ___\n___ 07:25AM BLOOD WBC-6.8 RBC-4.19* Hgb-12.7 Hct-37.2 \nMCV-89 MCH-30.5 MCHC-34.3 RDW-13.9 Plt ___\n___ 01:30PM BLOOD WBC-7.1 RBC-4.01* Hgb-12.1 Hct-35.6* \nMCV-89 MCH-30.2 MCHC-34.0 RDW-13.6 Plt ___\n___ 01:30PM BLOOD Neuts-67.0 ___ Monos-6.0 Eos-1.8 \nBaso-0.5\n___ 06:45AM BLOOD Glucose-83 UreaN-14 Creat-0.8 Na-145 \nK-4.4 Cl-109* HCO3-28 AnGap-12\n___ 07:25AM BLOOD Glucose-94 UreaN-11 Creat-0.7 Na-141 \nK-4.5 Cl-107 HCO3-28 AnGap-11\n___ 01:30PM BLOOD Glucose-97 UreaN-13 Creat-0.8 Na-143 \nK-4.2 Cl-108 HCO3-24 AnGap-15\n___ 07:25AM BLOOD CK(CPK)-24*\n___ 10:05PM BLOOD CK(CPK)-26\n___ 01:30PM BLOOD CK(CPK)-29\n___ 07:25AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 10:05PM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 01:30PM BLOOD cTropnT-<0.01\n___ 06:45AM BLOOD Cholest-170\n___ 07:25AM BLOOD Calcium-9.5 Phos-3.7 Mg-2.1\n___ 06:45AM BLOOD Triglyc-76 HDL-45 CHOL/HD-3.8 LDLcalc-110\n\nIMAGING: \nEKG ___: Sinus bradycardia. Compared to the previous tracing \nof ___ bradycardia is new. T waves are more upright in lead \naVL. \n\nCXR ___: No acute pulmonary process. New superior endplate \ncompression-type deformity of T12 which has occurred in the \ninterval since the prior exam. Otherwise acuity is unknown. \n\nHEAD MRI/MRA ___: No acute infarct. Normal appearing MRA of \nthe head.\nHOSPITAL COURSE BY PROBLEM:\n# Hypertensive emergency: Patient had high blood pressure \n(around 200) at home and in the ED, unclear reason. Initially \nreported that the patient was hypertensive at home and took \nextra blood pressure medications, however upon speaking with the \npatient further it seems that she just took her regular dose of \nantihypertensives before coming to the ED. Hypertenstion \nresolved when the pt was in the ED. HA and chest pain also \nresolved and were most likely result of the hypertension. \nPatient did have pressure to 180/110 on the floor the morning of \n___, but this resolved to 150/90 after patient received \nnormal dose of home antihypertensives ramipril and clonidine. \nBeta blocker was held given the patient's heart rate was in the \n___, and the patient says that this is usual for her (she holds \nher own beta blocker at home when her heart rate is in the ___. \n ___ was negative with 3 sets of cardiac enzymes <0.01, and EKG \nwith no changes over baseline. Unclear why patient was so \nhypertensive at home; may have to do with medication compliance \nissue, and she should follow up with PCP outpatient as may need \ntitration of home BP medication regimen.\n.\n# Chest pressure: Patient presented with chest pressure which \nwas likely from elevated SBP. Resolved after SBP came down. No \nEKG changes and ___ negative as per above. Patient monitored \non telemetry and there were no events.\n.\n# ?Neurological symptoms: Per report of patient's \ndaughter-in-law, patient may have had some leg numbness and some \nslurred speech at home the day prior to presentation. Because \nof the daughter's extreme concern that these symptoms may \nrepresent a TIA, a MRI/MRA of the head was performed and this \nwas normal. Lipid panel was also normal which decreases concern \nfor hyperlipidemia as a risk factor for TIA.\n.\n#FEN: heart healthy diet\n.\n#PPX: sc heparin, bowel reg\n.\n#Code: full"}}
|
{'final_diagnoses': ['Hypertensive urgency'], 'procedures': ['None'], 'visit_summary': "HOSPITAL COURSE BY PROBLEM:\n# Hypertensive emergency: Patient had high blood pressure \n(around 200) at home and in the ED, unclear reason. Initially \nreported that the patient was hypertensive at home and took \nextra blood pressure medications, however upon speaking with the \npatient further it seems that she just took her regular dose of \nantihypertensives before coming to the ED. Hypertenstion \nresolved when the pt was in the ED. HA and chest pain also \nresolved and were most likely result of the hypertension. \nPatient did have pressure to 180/110 on the floor the morning of \n___, but this resolved to 150/90 after patient received \nnormal dose of home antihypertensives ramipril and clonidine. \nBeta blocker was held given the patient's heart rate was in the \n___, and the patient says that this is usual for her (she holds \nher own beta blocker at home when her heart rate is in the ___. \n ___ was negative with 3 sets of cardiac enzymes <0.01, and EKG \nwith no changes over baseline. Unclear why patient was so \nhypertensive at home; may have to do with medication compliance \nissue, and she should follow up with PCP outpatient as may need \ntitration of home BP medication regimen.\n.\n# Chest pressure: Patient presented with chest pressure which \nwas likely from elevated SBP. Resolved after SBP came down. No \nEKG changes and ___ negative as per above. Patient monitored \non telemetry and there were no events.\n.\n# ?Neurological symptoms: Per report of patient's \ndaughter-in-law, patient may have had some leg numbness and some \nslurred speech at home the day prior to presentation. Because \nof the daughter's extreme concern that these symptoms may \nrepresent a TIA, a MRI/MRA of the head was performed and this \nwas normal. Lipid panel was also normal which decreases concern \nfor hyperlipidemia as a risk factor for TIA.\n.\n#FEN: heart healthy diet\n.\n#PPX: sc heparin, bowel reg\n.\n#Code: full", 'medications_prescribed': ['1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO once a day. ', '2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '3. Ramipril 5 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). ', '4. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Atenolol 25 mg Tablet Sig: One (1) Tablet PO Every morning. ', '6. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO every day at night. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 53, 'gender': 'M', 'symptoms': 's/p fall and finding of ___', 'medical_history': ['- R MCA stroke on ___', '- endocarditis', '- b/l renal infarcts', '- iv drug abuse: opiates, MDMA or "Ectasy", amphetamines', '- Asthma', '- Anxiety', '- Depression'], 'family_history': 'Denies any coronary artery disease or cancers in the family.', 'present_illness': 'The pt is a ___ y/o RHF with a history of iv drug abuse,\nendocarditis and R MCA stroke in ___, who presented with\nheadaches after a fall and was found to have a intracranial\nhemorrhage.\nShe reported that she had fallen yesterday and hit her head. She\nhad a headache yesterday and today, but no new neurologic\ndeficits, and was taken to ___, where a head CT showed\nfresh blood in the area of her stroke in the context of a\nsupratherapeutic INR of 3.4. She was transferred here for \nfurther\nmanagement.\nRegarding her prior history, she was admitted to ___ in ___ for treatment of endocarditis, likely related to iv drug\nabuse. She developed hypokinesa of her ventricle wall with\nreduced EF, was started on heparing and developed flaccid L\nhemiparesis a few hours later. She was found to have a large LV\nthrombus, which was later removed. Her echo upon discharge \nshowed\nmild hypokinesia, but a normal EF. She was supposed to be\ncontinued on warfarin for a total of 3 months.', 'medications': [{'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.32', 'valuenum': 3.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.7', 'valuenum': 47.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.9', 'valuenum': 45.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 178.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 165.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION Physical Exam:\nVitals: T:97.2 BP:102/67 SaO2:98\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, MMM.\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: Lungs CTA bilaterally \nCardiac: RRR, nl. S1S2 \nAbdomen: soft, NT/ND.\nExtremities: No edema or deformities.\nSkin: no rashes or lesions noted.\nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive, able to name ___ backward \nwithout\ndifficulty. Language is fluent with intact repetition and\ncomprehension. There were no paraphasic errors. Pt. was able\nto name ___ card items and read ___ card scentences. Speech\nwas mildly dysarthric. Able to follow both midline and\nappendicular commands. Pt. was able to register 3 objects and\nrecall ___ at 5 minutes. There was no evidence of apraxia.\n-Cranial Nerves:\nII: PERRL 3 to 2mm and brisk. VFF to confrontation. Unable to\nvisualize fundi.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch.\nVII: L facil droop\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n-Motor: Normal bulk. Minimal movement of left side. Has some \nmovement of left leg that is not antigravity. The right side \nstrength is intact.\n-Sensory: No deficits to light touch, \n-DTRs:\n Bi Tri ___ Pat Ach\nL 3+ 3+ 3+ 3+ 2+\nR 2 2 2 2 1\nPlantar response on R, mute on L, pronounced ankle and wrist \nclonus on l.\n-Coordination: No intention tremor, no dysdiadochokinesia noted \non R. \n-Gait: unable to walk\n\n=======================================\n\nDISCHARGE PHYSICAL EXAMINATION: \nVitals: Tm 98.3 BP 95-110/54-64 HR 58-69 RR18 POX 99RA\nHer exam demonstrates some inattention and tangentiality. She \nhas a left lower facial droop and mild dysarthria. Strength on \nthe right is full. Strength on the left arm is ___ with the \nexception of ___ at the deltoid. Strength on left leg is effort \ndependent but is at least the following: IP 3, Quad 4, Ham 3+, \nTA 2+, Gastroc 3+, ___ 3.', 'diagnoses': [{'icd_code': 'K56609', 'desc': 'Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction'}, {'icd_code': 'K458', 'desc': 'Other specified abdominal hernia without obstruction or gangrene'}, {'icd_code': 'Z85038', 'desc': 'Personal history of other malignant neoplasm of large intestine'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}], 'summary': 'ADMISSION LABS: \n___ 06:39PM BLOOD WBC-5.3 RBC-3.12* Hgb-8.6* Hct-27.3* \nMCV-88 MCH-27.7 MCHC-31.6 RDW-14.0 Plt ___\n___ 06:39PM BLOOD WBC-5.3 RBC-3.12* Hgb-8.6* Hct-27.3* \nMCV-88 MCH-27.7 MCHC-31.6 RDW-14.0 Plt ___\n___ 06:39PM BLOOD Neuts-45.0* ___ Monos-10.1 \nEos-13.7* Baso-0.7\n___ 06:39PM BLOOD ___ PTT-58.6* ___\n___ 06:39PM BLOOD Glucose-96 UreaN-24* Creat-0.7 Na-140 \nK-4.1 Cl-104 HCO3-27 AnGap-13\n___ 06:39PM BLOOD Calcium-9.0 Phos-4.8* Mg-2.0\n\nDISCHARGE LABS: \n___ 04:22PM BLOOD WBC-5.9 RBC-3.36* Hgb-9.2* Hct-29.8* \nMCV-89 MCH-27.4 MCHC-31.0 RDW-14.0 Plt ___\n___ 04:22PM BLOOD ___ PTT-29.1 ___\n___ 05:54AM BLOOD Glucose-86 UreaN-21* Creat-0.6 Na-139 \nK-4.3 Cl-102 HCO3-26 AnGap-15\n___ 05:54AM BLOOD ALT-54* AST-43* AlkPhos-134* TotBili-0.3\n___ 05:54AM BLOOD Calcium-9.9 Phos-4.8* Mg-2.0\nVanc trough was 16.2 the evening prior to discharge\nMs. ___ is a ___ year-old woman with active IVDU and recent \nhistory endocarditis with LV thrombus s/p surgical evacuation, \nrenal infarcts, and ischemic stroke of right MCA territory \n(right basal ganglia and right insular), who represented after a \nmechanical fall with new hemorrhagic conversion of her prior \nstroke while on systemic anticoagulation. \n\n# NEUROLOGY: \nShe was initially admitted to the neurology ICU where INR was \n3.4 and was actively reversed with FFP until 2.0. Afterwards \nher INR was allowed to passively trend downward and was not \nrestarted (see ___ section). Serial NCHCTs showed stability of \nthe hemorrhage. Her examination was notable for left \nhemiplegia, left facial droop and dysarthria. Movement of her \nleft leg did improve prior to discharge, but remained somewhat \neffort dependent.\n\n# CARDIOVASCULAR: \nIn setting of recent LV thrombus, s/p evacuation in ___, she had \na repeat echo which showed absence of LV thrombus or septal wall \naneurysm. After consultation with cardiac surgery, decision was \nmade to discontinue systemic anticoagulation indefinitely. She \nwill, however, need to have repeat echocardiograms every 2 weeks \nto evaluate for thrombus. She will also follow-up in cardiac \nsurgery clinic in 2 weeks. She remained hemodynamically stable \nduring her hospitalization with no evens on telemetry. She was \ncontinued on her home metoprolol.\n\n# INFECTIOUS DISEASE:\nRecent hospital admission with culture negative endocarditis \nwith septic renal emboli for which she was started on \nVanc/Cefepime. Her antibiotics were continued and she received \na PICC line for continued access. She did not spike a fever or \ndevelop leukocytosis during the admission. Plan is for 6 weeks \nof Vancomycin/ Cefepime through ___ and ID follow-up (see \nbelow). Please note cultures have been all negative.\n\n# PAIN MANAGEMENT: She has ongoing musculoskeletal pain of left \nshoulder which has potential (albeit low) of being related to \nher stroke. Given her history of opiate abuse, her pain regimen \nwas not escalated. We recommend increasing her gabapentin to a \ngoal dose of 600 TID, increasing by 100mg daily each 5 days. \nHer doses of morphine were not increased. \n\n# TRANSAMINITIS: She had transaminitis of unclear etiology last \nadmission. On recheck, mildly elevated. Hepaitis panel is \nnegative. We recommend repeating liver function tests on ___. \n\n# IV DRUG USE: Was ongoing issue last hospital admission \nincluding concern for IVDU while inpatient. No serum or urine \ntox screen repeated this admission. Could consider repeating \ngiven concern for use as inpatient.\n\n# ASTHMA. History of asthma, remained well control without use \nof rescue inhaler\n\n# Hospital Issues: Prophylaxis with SQH was restarted and can be \ncontinued at ___. Access with right PICC.'}}
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{'final_diagnoses': ['- Hemorrhagic stroke', '- Endocarditis'], 'procedures': ['RIGHT PICC LINE PLACED'], 'visit_summary': 'Ms. ___ is a ___ year-old woman with active IVDU and recent \nhistory endocarditis with LV thrombus s/p surgical evacuation, \nrenal infarcts, and ischemic stroke of right MCA territory \n(right basal ganglia and right insular), who represented after a \nmechanical fall with new hemorrhagic conversion of her prior \nstroke while on systemic anticoagulation. \n\n# NEUROLOGY: \nShe was initially admitted to the neurology ICU where INR was \n3.4 and was actively reversed with FFP until 2.0. Afterwards \nher INR was allowed to passively trend downward and was not \nrestarted (see ___ section). Serial NCHCTs showed stability of \nthe hemorrhage. Her examination was notable for left \nhemiplegia, left facial droop and dysarthria. Movement of her \nleft leg did improve prior to discharge, but remained somewhat \neffort dependent.\n\n# CARDIOVASCULAR: \nIn setting of recent LV thrombus, s/p evacuation in ___, she had \na repeat echo which showed absence of LV thrombus or septal wall \naneurysm. After consultation with cardiac surgery, decision was \nmade to discontinue systemic anticoagulation indefinitely. She \nwill, however, need to have repeat echocardiograms every 2 weeks \nto evaluate for thrombus. She will also follow-up in cardiac \nsurgery clinic in 2 weeks. She remained hemodynamically stable \nduring her hospitalization with no evens on telemetry. She was \ncontinued on her home metoprolol.\n\n# INFECTIOUS DISEASE:\nRecent hospital admission with culture negative endocarditis \nwith septic renal emboli for which she was started on \nVanc/Cefepime. Her antibiotics were continued and she received \na PICC line for continued access. She did not spike a fever or \ndevelop leukocytosis during the admission. Plan is for 6 weeks \nof Vancomycin/ Cefepime through ___ and ID follow-up (see \nbelow). Please note cultures have been all negative.\n\n# PAIN MANAGEMENT: She has ongoing musculoskeletal pain of left \nshoulder which has potential (albeit low) of being related to \nher stroke. Given her history of opiate abuse, her pain regimen \nwas not escalated. We recommend increasing her gabapentin to a \ngoal dose of 600 TID, increasing by 100mg daily each 5 days. \nHer doses of morphine were not increased. \n\n# TRANSAMINITIS: She had transaminitis of unclear etiology last \nadmission. On recheck, mildly elevated. Hepaitis panel is \nnegative. We recommend repeating liver function tests on ___. \n\n# IV DRUG USE: Was ongoing issue last hospital admission \nincluding concern for IVDU while inpatient. No serum or urine \ntox screen repeated this admission. Could consider repeating \ngiven concern for use as inpatient.\n\n# ASTHMA. History of asthma, remained well control without use \nof rescue inhaler\n\n# Hospital Issues: Prophylaxis with SQH was restarted and can be \ncontinued at ___. Access with right PICC.', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q4H:PRN pain, fever', '2. Bisacodyl ___AILY:PRN constipation', '3. CefePIME 2 g IV Q8H', '4. Docusate Sodium 100 mg PO BID', '5. Gabapentin 300 mg PO TID', '6. Heparin 5000 UNIT SC BID', '7. Metoprolol Tartrate 12.5 mg PO BID', '8. Morphine SR (MS ___ 30 mg PO Q12H \nRX *morphine 30 mg 1 capsule(s) by mouth every twelve (12) hours \nDisp #*30 Capsule Refills:*0', '9. Morphine Sulfate ___ 15 mg PO Q4H:PRN pain \nRX *morphine 15 mg 1 tablet(s) by mouth every four (4) hours \nDisp #*30 Tablet Refills:*0', '10. Polyethylene Glycol 17 g PO DAILY', '11. Ranitidine 150 mg PO BID', '12. Vancomycin 1250 mg IV Q 12H', '13. ClonazePAM 0.5 mg PO BID \nRX *clonazepam 0.5 mg 1 tablet(s) by mouth twice a day Disp #*30 \nTablet Refills:*0', '14. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing', '15. Lactulose 15 mL PO DAILY:PRN constipation']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 66, 'gender': 'F', 'symptoms': 'intermittent CP with nausea and SOB', 'medical_history': ['1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension', '2. CARDIAC HISTORY: \n-CABG: None \n-PERCUTANEOUS CORONARY INTERVENTIONS: ___ - stent \n-PACING/ICD: None', '3. OTHER PAST MEDICAL HISTORY: \n- Hypertension \n- Hyperlipidemia \n- CAD s/p DES in ___ \n- Benign Prostatic Hypertrophy \n- Bilateral total knee arthoplasty ___ years ago with \nrevisions in ___ and ___ \n- Bilateral Hernia repair \n- Osteoarthitis'], 'family_history': 'The patient has a brother who died of a \nmyocardial infarction at age ___. \n.', 'present_illness': 'The patient is a ___ yo M, who was being transferred from Dr. \n___ today with complaint of nausea and shortness of \nbreath for the past several days. The patient states that he was \nnot feeling well since ___, when he was exercising on a \nexercise bike as part of his knee rehab. Several minutes into \nthe exercise he felt lightheaded like he was going to passed \nout. He denies CP, SOB at that time. He stopped exercise and his \nsymptoms resolved. However, when he went home, he was walking up \nthe hill, when he suddenly found himself on the grass in front \nof his mailbox. The patient denies prodrome of dizziness. He \ndoes not remember any head trauma. He got up and went home. \nStated he did not want to come to the ED " because he did not \nwant to ruin ___\'s weekend." Later that day he felt \nlightheaded while getting up from a chair. On ___ morning, \nthe patient developed lightheadedness when getting up from his \nbed in the morning, and had similar symptoms on ___ morning. \nThe patient was not feeling well on ___ for most of the day \nand could not go to church, instead spending most of his day in \nbed, which he states is extremely unusual for him. The patient \nstated that this Morning he again was not feeling well, feeling \nnausea, lightheadedness, SOB. The patient\'s symptoms improved \nslightly after small breakfast, but then worsened again as he \nwas trying to come up the stairs of Dr. ___. The \npatient felt SOB, nauseous and lightheaded, and stated he has \nvery mild chest pressure and sinus pressure. Denies \npalpitations. EMS was called and the patient was sent to ___ \nED. \n. \n. \nEn route, the patient was complaining of some chest discomfort \nand sinus pressure. He was noted on the monitor to have HR up to \n250 consistent with SVT, but broke into sinus rhythm at ~ 120 \nprior to presentation to ED with complete resolution of \nsymptoms. \n. \n. \nIn the ER, initial vitals were 98.7 125 124/80 16 97. The \npatient was free of chest pain. Labs significant for \nhyperglycemia to 212. Cardiac enzymes were significant for \nTroponin of 0.11 ___Ks. \nEKG showed sinus rhythm at 127, left axis deviation, incomplete \nRBBB, mild upsloping ST changes in V4-V6. CXR was only \nisgnificant for mild bibasilar atelectasis. The patient given \nAspirin 325mg. \nOn transfer, vitals were 98.0 HR122 BP 121/88 RR16 100% on 2L \nNC. \n. \nOn evaluation on the floor, patient appeared comfortable and \nasymptomatic. He denied CP, SOB, dizziness, lightheadedness, \npalpitations.\n\nHe denies any prior history of stroke, TIA, deep venous \nthrombosis, pulmonary embolism, bleeding at the time of surgery, \nmyalgias, joint pains, cough, hemoptysis, black stools or red \nstools. He denies recent fevers, chills or rigors. He denies \nexertional buttock or calf pain. All of the other review of \nsystems were negative. \n. \nCardiac review of systems was as stated in HPI and is notable \nfor absence of chest pain, paroxysmal nocturnal dyspnea, \northopnea, ankle edema, palpitations.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate (CVICU Reversal Protocol)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'azelastine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NAS', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Niacinamide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'niacinamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'azelastine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IN', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Niacinamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'GuaiFENesin ER', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine (CVICU Reversal Protocol)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.79', 'valuenum': 1.79, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59.1', 'valuenum': 59.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '237', 'valuenum': 237.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.44', 'valuenum': 4.44, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.18', 'valuenum': 0.18, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.52', 'valuenum': 0.52, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9, . Estimated GFR = 63 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 227.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Slightly Hemolyzed specimen. Hemolysis falsely elevates this test.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.005', 'valuenum': 1.005, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.6, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Low risk <1.0, Average risk 1.0-3.0, High risk >3.0 (but <10).'}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Low risk <1.0, Average risk 1.0-3.0, High risk >3.0 (but <10).'}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 288.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Slightly Hemolyzed specimen. Hemolysis falsely elevates this test.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.7', 'valuenum': 44.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '311', 'valuenum': 311.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.02', 'valuenum': 5.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.2', 'valuenum': 43.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '361', 'valuenum': 361.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '264', 'valuenum': 264.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.22', 'valuenum': 1.22, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '398', 'valuenum': 398.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.39', 'valuenum': 2.39, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78.6', 'valuenum': 78.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '169', 'valuenum': 169.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.11', 'valuenum': 0.11, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.11', 'valuenum': 0.11, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.08', 'valuenum': 10.08, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '226', 'valuenum': 226.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '192', 'valuenum': 192.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '310', 'valuenum': 310.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.76', 'valuenum': 3.76, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.5, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Low risk <1.0, Average risk 1.0-3.0, High risk >3.0 (but <10).'}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 380.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '337', 'valuenum': 337.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.38, 'valueuom': 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None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.0', 'valuenum': 22.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.1', 'valuenum': 46.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': 'GREATER THAN 300. LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 285.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '345', 'valuenum': 345.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 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'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 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'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 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'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.39', 'valuenum': 2.39, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.9', 'valuenum': 46.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 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'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '434', 'valuenum': 434.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '591', 'valuenum': 591.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '>300. 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'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.5', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '285', 'valuenum': 285.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '396', 'valuenum': 396.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.5', 'valuenum': 45.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '423', 'valuenum': 423.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '304', 'valuenum': 304.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '460', 'valuenum': 460.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '540', 'valuenum': 540.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '318', 'valuenum': 318.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '263', 'valuenum': 263.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.24', 'valuenum': 3.24, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.2', 'valuenum': 47.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '349', 'valuenum': 349.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS: T=97.5F BP=116/66 HR= 127 RR=18 O2 sat= 96% on 2L NC \nGENERAL: WDWN M in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple no JVP elevation \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. Regular rhythm, tachycardic, normal S1, S2. No m/r/g. No \nthrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not \nenlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. Bilateral well-healed scars over knees \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': 'I080', 'desc': 'Rheumatic disorders of both mitral and aortic valves'}, {'icd_code': 'I442', 'desc': 'Atrioventricular block, complete'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'I110', 'desc': 'Hypertensive heart disease with heart failure'}, {'icd_code': 'I5030', 'desc': 'Unspecified diastolic (congestive) heart failure'}, {'icd_code': 'I452', 'desc': 'Bifascicular block'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'I440', 'desc': 'Atrioventricular block, first degree'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}, {'icd_code': 'Z8774', 'desc': 'Personal history of (corrected) congenital malformations of heart and circulatory system'}, {'icd_code': 'Z8589', 'desc': 'Personal history of malignant neoplasm of other organs and systems'}], 'summary': "Labs on Admission:\n\n___ 10:55AM BLOOD WBC-5.8 RBC-4.60 Hgb-13.1* Hct-41.1 \nMCV-89 MCH-28.5 MCHC-31.9 RDW-15.1 Plt ___\n___ 10:55AM BLOOD Neuts-74.1* ___ Monos-4.3 Eos-2.7 \nBaso-0.2\n___ 10:55AM BLOOD ___ PTT-25.9 ___\n___ 10:55AM BLOOD Glucose-212* UreaN-23* Creat-1.2 Na-142 \nK-4.4 Cl-105 HCO3-28 AnGap-13\n___ 10:55AM BLOOD TSH-2.4\n___:55AM BLOOD T4-7.3\n___ 10:56AM BLOOD Hgb-13.6* calcHCT-41\n___ 10:56AM BLOOD Glucose-202* Lactate-2.0 Na-143 K-4.5 \nCl-102 calHCO3-26\n\nCardiac Biomarkers:\n\n___ 10:55AM BLOOD CK(CPK)-74\n___ 10:55AM BLOOD cTropnT-0.11*\n___ 09:50PM BLOOD CK-MB-NotDone cTropnT-0.84*\n___ 09:00AM BLOOD CK-MB-NotDone cTropnT-0.86*\n___ 10:55AM BLOOD Calcium-9.0 Phos-3.0 Mg-2.0\n\nECHO ___:\nThe left atrium is normal in size. There is mild symmetric left \nventricular hypertrophy. The left ventricular cavity size is \nnormal. Overall left ventricular systolic function is normal \n(LVEF>55%). Tissue Doppler imaging suggests a normal left \nventricular filling pressure (PCWP<12mmHg). The right \nventricular cavity is dilated with normal free wall \ncontractility. The aortic root is mildly dilated at the sinus \nlevel. The ascending aorta is mildly dilated. The aortic valve \nleaflets (3) appear structurally normal with good leaflet \nexcursion and no aortic regurgitation. The mitral valve leaflets \nare mildly thickened. Mild (1+) mitral regurgitation is seen \n(although appears more significant in some views). There is a \nvery small pericardial effusion. There are no echocardiographic \nsigns of tamponade. \n\nCARDIAC CATH ___:\n1. Coronary angiography in this left-dominant system \ndemonstrated no \nsignificant coroanry artery disease. The LMCA, LAD, LCx and RCA \nwere \nwithout angiographically apparent disease. The prior ramus stent \nhad 30% \nin-stent restenosis. \n2. Limited resting hemodynamcis revealed elevated left-sided \nfilling \npressures, with an LVEDP of 26 mm Hg. There was moderate \nsystemic \narterial hypertension, with an SBP of 154 mm Hg. There was no \ngradient \nupon pullback of the catheter from the left ventricle to the \naorta.\n___ yo M with HTN, HLD, CAD s/p DES in ___, now p/w seevral days \nof DOE, nausea, lightheadedness, s/p syncopal episode, found to \nhave SVT to HR of 240, which broke on EMS ride with resolution \nof symptoms. \n. \n# CORONARIES: Trop 0.11 ___Ks with Cr 1.2 on initial \ncardiac enzymes in ED. Given rates to 250s documented by EMS, \nthis most likely represented rate-related ischemia. However, \ngiven risk factors, h/o CAD requiring prior stenting, myocardial \ninfarction was ruled out by cycling cardiac enzymes. The \npatient was monitored on Telemetry and continued on Aspirin \n325mg daily and Toprol XL. Echo was performed which revealed \nnormal left systolic function (LVEF of 55%) and mild (1+) mitral \nregurgitation. Given findings during EP study concerning for \nworsening CAD, cardiac catheterization was performed which \nshowed stable coronaries requiring no intervention. \nSubsequently, the patient's Aspirin dose was decreased to 81mg \ndaily.\n. \n# PUMP: Normal ejection fraction on Echo from ___ and \ncardiolite study from ___. Echo was performed during this \nadmission which revealed normal left systolic function (LVEF of \n55%) and mild (1+) mitral regurgitation. We continued beta \nblocker and Aspirin as above. \n. \n# RHYTHM: SVT to 250s during EMS ride, but broke before \npresentation to ED to sinus in 120s. Unclear the reason for \nsinus tachycardia, as the patient did not appear dehydrated, but \nmild IV hydration was given. Thyroid function was wnl. The \npatient was monitored on Telemetry and EP study this afternoon \nwith successful SVT ablation. The patient remained in NSR \nfollowing the procedure. \n. \n# Hypertension: We continued Toprol XL 12.5 mg daily \n. \n# Hyperlipidemia: we continued Statin \n. \n# Benign Prostatic Hypertrophy: we continued outpatient Vesicare \nand Uroxatral \n. \n# Bilateral Knee Replacement - pt. states no difficulty with \nambulation since revision. He will continue outpatient rehab. \n."}}
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{'final_diagnoses': ['atrial flutter status post ablation', 'coronary artery disease', 'hypertension', 'hyperlipidemia'], 'procedures': ['Ablation of atrial flutter', 'cardiac catheterization'], 'visit_summary': "___ yo M with HTN, HLD, CAD s/p DES in ___, now p/w seevral days \nof DOE, nausea, lightheadedness, s/p syncopal episode, found to \nhave SVT to HR of 240, which broke on EMS ride with resolution \nof symptoms. \n. \n# CORONARIES: Trop 0.11 ___Ks with Cr 1.2 on initial \ncardiac enzymes in ED. Given rates to 250s documented by EMS, \nthis most likely represented rate-related ischemia. However, \ngiven risk factors, h/o CAD requiring prior stenting, myocardial \ninfarction was ruled out by cycling cardiac enzymes. The \npatient was monitored on Telemetry and continued on Aspirin \n325mg daily and Toprol XL. Echo was performed which revealed \nnormal left systolic function (LVEF of 55%) and mild (1+) mitral \nregurgitation. Given findings during EP study concerning for \nworsening CAD, cardiac catheterization was performed which \nshowed stable coronaries requiring no intervention. \nSubsequently, the patient's Aspirin dose was decreased to 81mg \ndaily.\n. \n# PUMP: Normal ejection fraction on Echo from ___ and \ncardiolite study from ___. Echo was performed during this \nadmission which revealed normal left systolic function (LVEF of \n55%) and mild (1+) mitral regurgitation. We continued beta \nblocker and Aspirin as above. \n. \n# RHYTHM: SVT to 250s during EMS ride, but broke before \npresentation to ED to sinus in 120s. Unclear the reason for \nsinus tachycardia, as the patient did not appear dehydrated, but \nmild IV hydration was given. Thyroid function was wnl. The \npatient was monitored on Telemetry and EP study this afternoon \nwith successful SVT ablation. The patient remained in NSR \nfollowing the procedure. \n. \n# Hypertension: We continued Toprol XL 12.5 mg daily \n. \n# Hyperlipidemia: we continued Statin \n. \n# Benign Prostatic Hypertrophy: we continued outpatient Vesicare \nand Uroxatral \n. \n# Bilateral Knee Replacement - pt. states no difficulty with \nambulation since revision. He will continue outpatient rehab. \n.", 'medications_prescribed': ['1. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: 0.5 Tablet Sustained Release 24 hr PO DAILY (Daily).\nDisp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*', '2. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', '3. Fexofenadine 60 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily).', '4. Rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', '6. Vesicare 5 mg Tablet Sig: One (1) Tablet PO once a day.', '7. Uroxatral 10 mg Tablet Sustained Release 24 hr Sig: One (1) \nTablet Sustained Release 24 hr PO once a day.', '8. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) injection \nSubcutaneous Q12H (every 12 hours): Until told to stop by Dr. \n___.Disp:*14 injections* Refills:*2*', '9. Outpatient Lab Work\nPlease draw ___, PTT, INR on ___ and fax results to Dr. \n___ at fax ___', '10. Warfarin 1 mg Tablet Sig: as directed Tablet PO once a day: \nDose as directed by Dr. ___ at 4pm each day. Please use a \ncombination of 1mg and 2mg pills for the required dose. .Disp:*30 Tablet(s)* Refills:*2*', '11. Warfarin 2.5 mg Tablet Sig: as directed Tablet PO daily at \n4pm: Take 4 pills (10mg daily) today ___. Then 2 pills \n(5mg daily) until told otherwise by Dr. ___.Disp:*30 Tablet(s)* Refills:*2*', '12. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.Disp:*30 Tablet(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 47, 'gender': 'M', 'symptoms': 'suicide attempt', 'medical_history': ['Cirrhosis', 'Anxiety/Depression'], 'family_history': 'FAMILY PSYCHIATRIC HISTORY:\n -Fam Dx: denies\n -Fam Hospitalizations: denies\n -Fam Treatment Hx/Med Trials: denies\n -Fam Hx Suicide: denies', 'present_illness': '___ male with a history of cirrhosis chronic alcohol use\nquestion and recent inpatient admission at ___ released on ___ who presented to twice daily MCA via\nEMS after found in a park with self-induced wrist lacerations \nand\nhemorrhage at the scene. The patient required trauma survey \nwith\nacute care surgery consult and CT torso with contrast which\ndisclosed hematoma on his left flank but no other evidence of\ntrauma in the torso. The patient required stapling of his left\nwrist laceration and substantial IV fluid administration for ED\nvitals notable for a heart rate of 110 and a BP of 60 over palp.\ninitial labs were notable for a hemoglobin of 9.7 which then\ndropped to 6.4 and he was then transfused 2 units of RBCs with a\nhemoglobin this morning of 7.8. His initial lactate is 6.9\nnormalized. Urine tox screen was positive for benzos and he had\nan alcohol level in the 300s. \n\nPsychiatry consulted in the emergency department and the patient\nwas also treated with Valium for low-grade alcohol withdrawal. \nPatient was placed on a suicide precaution with a sitter and had\na ___ order. He states that he had been sober for 10\nmonths and then 2 weeks ago because of life stressors he started\nconsuming alcohol heavily again.\n\nBecause of persistent anemia and thrombocytopenia and\nunderstanding that it would take some time for a bed search for\nan inpatient psychiatry bed and that he required further medical\nstability he was hospitalized on ___ this evening.\n\nROS:\nNotable for an occipital headache of 7 out of 10 without visual\nchanges or neck pain, he has sharp pain at the site of his left\nwrist laceration. He does not have any GI symptoms including\nnausea vomiting abdominal pain or constipation. He denies\nepisodes of variceal hemorrhage or symptomatic ascites recently. \n\nNo chest pain or shortness of breath. 10 point review of \nsystems\nis otherwise negative.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SUBCUT', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Hepatitis B Vaccine (20 mcg/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENObarbital - ICU Alcohol Withdrawal (Initial Load / Rescue Dose)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.30', 'valuenum': 1.3, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '68.8', 'valuenum': 68.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, 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'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '274', 'valuenum': 274.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 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'104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53.6', 'valuenum': 53.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2458.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '317', 'valuenum': 317.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 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'comments': None}, {'value': '/20.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '148', 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'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.353', 'valuenum': 0.353, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, 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None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '402', 'valuenum': 402.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'log10 IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.353', 'valuenum': 0.353, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.0', 'valuenum': 52.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1467.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.4', 'valuenum': 52.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.8', 'valuenum': 52.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.3', 'valuenum': 40.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54.5', 'valuenum': 54.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Exam data\n___ 1730 Temp: 98.4 PO BP: 93/58 L Sitting HR: 92 RR: 18 O2\nsat: 100% O2 delivery: Room Air Dyspnea: 0 RASS: 0 Pain Score: \n___\nHe is awake alert attentive and speaks fluently without any \nsigns\nof confusion, he does not have any visible trauma\nTo his occiput or head\nHe has moist mucous membranes and there is no scleral icterus.\nBreath sounds are equal and symmetric bilaterally without rales\nHe has S1 and S2 without audible murmur\nThere is no palpable hepato-or splenomegaly abdomen is soft and\nnondistended without clinically evident ascites.\nThere is bruising on his left flank\nHe does not have any peripheral edema.\nThe repaired left wrist laceration is bandaged and gauze\nHe is calm without pressured speech.\nHe is able to extend both hands without much of a tremor but \nwhen\nI measure his pulse in his right radial artery he does begin to\nshake just that right hand and then it comes to arrest as he \nputs\nit down in bed and I measure his pulse in the opposite hand\nNo visible rashes to torso or extremities\n\nDischarge Exam: \nVITALS: ___ 0748 Temp: 97.7 PO BP: 110/65 HR: 82 RR: 20 O2\nsat: 99% O2 delivery: RA \nGENERAL: Alert, sitting up in bed\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. \nOropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur.\nRESP: CTAB Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. No HSM\nMSK: Clean dry and intact bandage in place on his left wrist.\nNEURO: Alert, oriented, face symmetric, speech fluent, tremor. \nPSYCH: Flat affect', 'diagnoses': [{'icd_code': 'F10231', 'desc': 'Alcohol dependence with withdrawal delirium'}, {'icd_code': 'J690', 'desc': 'Pneumonitis due to inhalation of food and vomit'}, {'icd_code': 'G92', 'desc': 'Toxic encephalopathy'}, {'icd_code': 'G4089', 'desc': 'Other seizures'}, {'icd_code': 'M6282', 'desc': 'Rhabdomyolysis'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'K7030', 'desc': 'Alcoholic cirrhosis of liver without ascites'}, {'icd_code': 'K7010', 'desc': 'Alcoholic hepatitis without ascites'}, {'icd_code': 'T510X2A', 'desc': 'Toxic effect of ethanol, intentional self-harm, initial encounter'}, {'icd_code': 'F22', 'desc': 'Delusional disorders'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'S069X0A', 'desc': 'Unspecified intracranial injury without loss of consciousness, initial encounter'}, {'icd_code': 'R1013', 'desc': 'Epigastric pain'}, {'icd_code': 'R946', 'desc': 'Abnormal results of thyroid function studies'}, {'icd_code': 'Z597', 'desc': 'Insufficient social insurance and welfare support'}, {'icd_code': 'E876', 'desc': 'Hypokalemia'}, {'icd_code': 'I4581', 'desc': 'Long QT syndrome'}, {'icd_code': 'S0093XA', 'desc': 'Contusion of unspecified part of head, initial encounter'}, {'icd_code': 'F209', 'desc': 'Schizophrenia, unspecified'}, {'icd_code': 'F39', 'desc': 'Unspecified mood [affective] disorder'}, {'icd_code': 'F6089', 'desc': 'Other specific personality disorders'}, {'icd_code': 'R791', 'desc': 'Abnormal coagulation profile'}, {'icd_code': 'D531', 'desc': 'Other megaloblastic anemias, not elsewhere classified'}, {'icd_code': 'R61', 'desc': 'Generalized hyperhidrosis'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'G252', 'desc': 'Other specified forms of tremor'}, {'icd_code': 'S098XXA', 'desc': 'Other specified injuries of head, initial encounter'}], 'summary': 'Admission Labs: \n___ 12:34PM BLOOD WBC-8.6 RBC-3.13* Hgb-9.7* Hct-29.0* \nMCV-93 MCH-31.0 MCHC-33.4 RDW-16.5* RDWSD-55.7* Plt ___\n___ 12:34PM BLOOD ___ PTT-27.0 ___\n___ 04:33PM BLOOD Glucose-139* UreaN-18 Creat-1.0 Na-144 \nK-4.3 Cl-112* HCO3-18* AnGap-14\n___ 12:34PM BLOOD ALT-31 AST-69* AlkPhos-69 TotBili-0.5\n___ 12:34PM BLOOD Albumin-2.6*\n___ 12:34PM BLOOD Albumin-2.6*\n___ 12:34PM BLOOD ASA-NEG ___ Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 12:45PM BLOOD ___ pO2-40* pCO2-34* pH-7.28* \ncalTCO2-17* Base XS--9\n___ 12:45PM BLOOD Glucose-100 Lactate-6.9* Na-145 K-4.0 \nCl-117*\n___ 12:45PM BLOOD Hgb-9.9* calcHCT-30\n___ 12:45PM BLOOD freeCa-1.05*\n\nImaging: \nCT ABD/Pelvis\n1. Small left flank soft tissue ecchymosis. No other evidence \nof trauma in the torso. \n2. Cirrhotic liver with sequelae of portal hypertension \nincluding small volume ascites, splenomegaly, and large \nportosystemic shunts. \n\nDischarge Labs: \n\n___ 03:05PM BLOOD WBC-7.0 RBC-2.94* Hgb-9.0* Hct-26.9* \nMCV-92 MCH-30.6 MCHC-33.5 RDW-16.1* RDWSD-51.9* Plt ___\n___ 03:05PM BLOOD Glucose-98 UreaN-14 Creat-0.8 Na-140 \nK-4.1 Cl-107 HCO3-22 AnGap-11\n___ 07:10AM BLOOD Calcium-8.5 Phos-4.1 Mg-1.___\nman who in the setting of alcohol use relapse and \nsuicide attempt with laceration of his right wrist on ___ \nexperienced transient hypotension and acute blood loss anemia \nrequiring blood transfusion which stabilized his blood counts. \n\nACUTE/ACTIVE PROBLEMS:\n# Depression/Anxiety\n# Suicide Attempt: Found in park by EMS with left wrist slashed. \nAppears to be intentional suicide attempt and the patient \nreports that he felt "empty inside". Psych consulted in the ED. \nFollowing medical clearance, psych reevaluated the patient and \ndeemed that he would warrant inpatient psychiatric stay. He will \nbe placed in a duel diagnosis facility following discharge in \nthe hospital on a ___. Currently holding home prazosin \nand sertraline. \n\n# EtOH abuse with relapse and withdrawal: Sober for 10 months \nand then drinking for the last ___ weeks "as much as I can get \nme hands on until I black out every day". He was initially on a \nvalium CIWA and was changed to ATIVAN CIWA given his liver\ndysfunction. He completed withdrawal on ___ and was taken off \nAtivan. \n- Hold on vivitrol for now. If continues to improve then can \nstart oral naltrexone at a low-dose, 12.5-25 mg, for several \nweeks and then repeat LFTs including AST, ALT, ___, albumin, and \nboth direct and indirect bilirubin. If those were okay after \ntwo to four weeks of low-dose oral naltrexone, Vivitrol would be \nreasonable.\n\n# Acute blood loss anemia: Required transfusion in ED. Hgb now \nstable. Discharge hemoglobin 9. \n\n# Left wrist laceration: Intentional suicide attempt. Staples in \nplace with ACS. NO loss of function with intact sensation and \ngood color. Staples removed by ACS prior to D/C. \n\n# Chronic Liver Disease causing \n# Thrombocytopenia: Obtained records from PCP ___. He has \nCirrhosis on MRI. Work-up unrevealing. Notable for only H63D \nhetero mutation which is not usually related to hemochromatosis. \nHe was referred for Hepatology evaluation x2 as an outpatient \nbut\nbut never made an appointment. Held home lactulose, Lasix and \naldactone given low BP on admission. Restarted later in the \nhospitalization. He should have an outpatient appointment for \nevaluation. He is referred to outpatient hepatology at ___. \n\nGreater than 30 minutes spent in care coordination and \ncounseling on the day of discharge.'}}
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{'final_diagnoses': ['Suicide attempt', 'Alcohol Withdrawal', 'Cirrhosis'], 'procedures': ['None'], 'visit_summary': 'man who in the setting of alcohol use relapse and \nsuicide attempt with laceration of his right wrist on ___ \nexperienced transient hypotension and acute blood loss anemia \nrequiring blood transfusion which stabilized his blood counts. \n\nACUTE/ACTIVE PROBLEMS:\n# Depression/Anxiety\n# Suicide Attempt: Found in park by EMS with left wrist slashed. \nAppears to be intentional suicide attempt and the patient \nreports that he felt "empty inside". Psych consulted in the ED. \nFollowing medical clearance, psych reevaluated the patient and \ndeemed that he would warrant inpatient psychiatric stay. He will \nbe placed in a duel diagnosis facility following discharge in \nthe hospital on a ___. Currently holding home prazosin \nand sertraline. \n\n# EtOH abuse with relapse and withdrawal: Sober for 10 months \nand then drinking for the last ___ weeks "as much as I can get \nme hands on until I black out every day". He was initially on a \nvalium CIWA and was changed to ATIVAN CIWA given his liver\ndysfunction. He completed withdrawal on ___ and was taken off \nAtivan. \n- Hold on vivitrol for now. If continues to improve then can \nstart oral naltrexone at a low-dose, 12.5-25 mg, for several \nweeks and then repeat LFTs including AST, ALT, ___, albumin, and \nboth direct and indirect bilirubin. If those were okay after \ntwo to four weeks of low-dose oral naltrexone, Vivitrol would be \nreasonable.\n\n# Acute blood loss anemia: Required transfusion in ED. Hgb now \nstable. Discharge hemoglobin 9. \n\n# Left wrist laceration: Intentional suicide attempt. Staples in \nplace with ACS. NO loss of function with intact sensation and \ngood color. Staples removed by ACS prior to D/C. \n\n# Chronic Liver Disease causing \n# Thrombocytopenia: Obtained records from PCP ___. He has \nCirrhosis on MRI. Work-up unrevealing. Notable for only H63D \nhetero mutation which is not usually related to hemochromatosis. \nHe was referred for Hepatology evaluation x2 as an outpatient \nbut\nbut never made an appointment. Held home lactulose, Lasix and \naldactone given low BP on admission. Restarted later in the \nhospitalization. He should have an outpatient appointment for \nevaluation. He is referred to outpatient hepatology at ___. \n\nGreater than 30 minutes spent in care coordination and \ncounseling on the day of discharge.', 'medications_prescribed': ['Acetaminophen 500 mg PO Q6H:PRN Pain', 'FoLIC Acid 1 mg PO DAILY', 'Ibuprofen 400 mg PO Q8H:PRN Pain - Moderate \nDo not take for more than 5 days. ', 'Thiamine 100 mg PO DAILY', 'Furosemide 40 mg PO DAILY', 'Lactulose 15 mL PO DAILY', 'Spironolactone 100 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Nausea/Vomiting', 'medical_history': ['Bladder Cancer Depression, hypertension, eczema, history\nof SVT, GERD, hyperlipidemia, OSA, BPH, gout', '___: Presents with hematuria and clots in urine during\npreceding year. TURBT shows invasive high-grade papillary\ntransitional cell carcinoma of the bladder, invading into the\nlamina propria but not the muscularis propria, as well as CIS in\nthe prostatic urethra. Opts for re-staging biopsy at that time.', '___: Repeat TURBT shows T1 disease, Grade 3.', '___: Intravesicular BCG therapy initiated x 6 weekly\ndoses.', '___: Repeat cystoscopy shows erythrematous,\nvillous-appearing areas, suspicious for recurrence; however,\nbiopsies were negative.', '___: CT normal.', '___: Maintenance BCG initiated x 3 doses.', '___: Routine cystoscopy shows a patch of inflammation, \nwith\nsuspicious urine cytology but negative biopsy.', '___: Urine cytology positive for bladder cancer.', '___: BCG/interferon x 6 weeks', '___: TURBT, with bladder neck resection showing a papillary\ntumor in the submucosa, high-grade urothelial carcinoma, \ninvading\ninto the muscularis propria of the bladder neck, involving the\nprostatic/periurethral ducts.', '___: C1D1 of dose-dense MVAC for neoadjuvant chemotherapy', '___: C2D1 of dose-dense MVAC with carboplatin substituted\nfor cisplatin in the setting of elevated creatinine.', '___: C3D1 of dose-dense MVACarboplatin.', '___: C4D1 of dose-dense MVACarboplatin, complicated by\nfebrile neutropenia.', '___: Robotic laparoscopic radical \ncystectomy/prostatectomy\nwith ileal loop diversion by Dr. ___ Dr. ___, with RPLN\ndissection. High-grade urothelial carcinoma involving prostate\nthrough intraductal spread and early stromal invasion, involving\nseminal vesicles through lymphatic vascular spread. Margins\nnegative. 0 of 19 lymph nodes involved. pT4N0Mx.', '___: CT torso with no evidence of metastatic or recurrent\ndisease.', '___: CT torso with no evidence of metastatic or recurrent\ndisease.', '___: Surveillance CT shows no evidence of recurrent or\nresidual disease in the abdomen or pelvis, as well as increase \nin\nsize of a right paratracheal mediastinal lymph node (11 x 25 \nmm).', '___: Surveillance CT shows interval enlargement of right\nparatracheal lymph node (17 x 28 mm).', '___: Transbronchial biopsy of right paratracheal lymph node\nreveals metastatic bladder cancer.', '___: PET scan shows the FDG-avid 30 x 18 mm right\nparatracheal mass, as well as an 8 mm right supraclavicular \nlymph\nnode. There were also a few FDG-avid right inguinal lymph nodes,\nwhich were stable in size since ___, likely reactive to\ncystoprostatectomy and ileal loop urinary diversion.', '___: Discussion at ___ Oncology Tumor Board yields plan to\nperform radiotherapy to paratracheal mass and right\nsupraclavicular lymph node with concurrent low-dose weekly\npaclitaxel.', '___: C1D1 of low-dose weekly paclitaxel (50 mg/m2) with\nconcurrent radiotherapy.', '___: C1D8 of low-dose weekly paclitaxel (50 mg/m2) with\nconcurrent radiotherapy.', '___: C1D15 of low-dose weekly paclitaxel (50 mg/m2) with\nconcurrent radiotherapy.', '___: C1D21 of low-dose weekly paclitaxel (50 mg/m2) with\nconcurrent radiotherapy.', '___: Radiotherapy concludes.', '___: Surveillance CT torso shows that his known previously\nenlarged and FDG-avid paratracheal lymph node have substantially\ndecreased in size (now 12 mm, previously 30 mm). New bilateral\nparamediastinal parenchymal opacities, given their geographic\ndistribution, are thought to be consistent with post-radiation\nchanges. There is no evidence of local recurrence or distant\nmetastatic disease in the abdomen.', '___: Surveillance CT torso shows stable appearance of the\nchest, including interval decrease in size of the right\nparatracheal lymphadenopathy, and no evidence of local or\nrecurrent metastatic disease in the abdomen or pelvis.', '___: Surveillance CT torso shows a 16 mm high \npre-tracheal\nlymph node, intervally increased in size, suspicious for\nmetastatic recurrence.', '___: Surveillance CT torso demonstrates continued slight\nincrease in growth of the right pre-tracheal lymph node (to 17\nmm, previously 16 mm), with no new sites of disease.', '___: Surveillance CT torso shows continued interval growth\nof the right paratracheal lymph node (from 1.6 x 1.5 cm to 1.9 x\n2.1 cm), with no evidence of recurrent or metastatic disease in\nthe abdomen or pelvis.', '___: increase size of disease in mediastinum', '___: Started atezo', '___: ___ held for concern for pneumonitis (ultimately \nnot\nfelt to be pneumonitis)', '___: C2D1 Atezo', '___: C3D1 Atezo', '___: C4D1 Atezo', '___: CT torso revealed interval growth in right mediastinal\nmass, new right pleural nodularity, new sub cm right lung nodule', '___: C1D1 gem/cis', '___: gem held given neulasta', '___: C2D1 gem/cis'], 'family_history': 'No GU Cancers. Son with thyroid ca, brother died suddenly of\nunclear cause at ___ yrs of age.', 'present_illness': '___ is a ___ gentleman with a PMH significant\nfor bladder cancer, CKD, atrial fibrillation on xeralto, HLD, DM\nwho presents with nausea and vomiting with inability to take\nanything by mouth. He reports since ___ morning he has been\nnauseous and vomiting non-bloody non-bilious emesis. He has been\nable to keep only small amounts of clear liquids down. No\nfevers, chills, diarrhea, hematochezia, melena, chest pain,\nshortness of breath, cough, swelling in arms or legs.\n\nIn the clinic, initial VS were: BP 117/85 HR 97 SaO2 98%RA \nT97.5 RR18\n\nLabs were notable for:\n\n___ |46\n==========<\n4.8|17 |2.2 \n\nCa: 8.7 Mg: 1.6 P: 5.6\n\nALT: 13 AP: 98 Tbili: 0.9 Alb: \nAST: 16 \n\n65.5> 10.2/31.1 <145 \n With neutrophilic predominance\n\nTreatments received: \n2 L IVF\nOndansetron 8 mg IV ASDIR \n\nOn arrival to the floor, patient was tachycardic but sitting in\nchair in NAD.\n\nREVIEW OF SYSTEMS: \nA complete 10-point review of systems was performed and was\nnegative unless otherwise noted in the HPI.', 'medications': [{'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin Enema', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin A', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LamoTRIgine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LamoTRIgine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'NORepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Zinc Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'rifAXIMin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin A', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Oxymetazoline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 560.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 229.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72.6', 'valuenum': 72.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.83', 'valuenum': 0.83, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.36', 'valuenum': 5.36, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60.1', 'valuenum': 60.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 49.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Effective ___, values will be reported from the ___ Vitamin D. Total assay. This assay accurately detects 25-hydroxyvitamin D3 but. does not accurately detect 25-hydroxyvitamin D2 and values may not be. accurate in patients taking vitamin D2 (ergocalciferol)..'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.49', 'valuenum': 3.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58.1', 'valuenum': 58.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.9', 'valuenum': 19.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.5', 'valuenum': 57.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Verified by smear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW*.'}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.9', 'valuenum': 56.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '364', 'valuenum': 364.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.4', 'valuenum': 57.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 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{'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.54', 'valuenum': 3.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.0', 'valuenum': 57.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 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None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '273', 'valuenum': 273.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58.2', 'valuenum': 58.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.0', 'valuenum': 56.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.7', 'valuenum': 56.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '275', 'valuenum': 275.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.7', 'valuenum': 56.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '169', 'valuenum': 169.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 175.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '346', 'valuenum': 346.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58.4', 'valuenum': 58.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely decreases this test.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 180.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 192.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '265', 'valuenum': 265.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 569.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 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None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '58.3', 'valuenum': 58.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59.3', 'valuenum': 59.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59.7', 'valuenum': 59.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 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'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.0', 'valuenum': 52.0, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.3', 'valuenum': 63.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '54', 'valuenum': 54.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.26', 'valuenum': 3.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.6', 'valuenum': 63.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '52', 'valuenum': 52.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65.1', 'valuenum': 65.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 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70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 225.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 151.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '54.0', 'valuenum': 54.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.92', 'valuenum': 2.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72.6', 'valuenum': 72.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '73.1', 'valuenum': 73.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 155.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'ADMISSION PHYSICAL EXAM:\n=======================\nVitals: T 98.0 PO BP 112/72 HR136 RR18 SaO2 100% RA \nGENERAL: Pleasant, lying in bed comfortably\nHEENT: EOMI, L pupil >R both reactive to light\nCARDIAC: irreg irreg, tachy , no murmurs\nLUNG: Appears in no respiratory distress, clear to auscultation\nbilaterally, no crackles, wheezes, or rhonchi\nABD: Normal bowel sounds, soft, nontender, nondistended, no\nhepatomegaly, no splenomegaly\nEXT: Warm, well perfused, no lower extremity edema\nPULSES: 2+ radial pulses\nNEURO: Alert, oriented, CN II-XII intact, motor and sensory\nfunction grossly intact\nSKIN: No significant rashes\n\nDISCHARGE PHYSICAL EXAM:\n========================\nVitals: Afebrile, BP 100s-130s/60s-70s, HR 100s, RR 18, RA\nI/O yest: 1.1 L PO, 1 L IV / 1.7 L urostomy\nGeneral: Pleasant, lying in bed comfortably\nHEENT: EOMI, L pupil > R both reactive to light\nCardiac: irreg irreg, tachy, no murmurs\nPulm: CTAB, no w,r,r\nAbd: NTTP, NBS, ND, urostomy bag in tact with maroon-colored \nurine.\nExt: Warm, well perfused, no lower extremity edema, 2+ radial \npulses\nNeuro: Alert, oriented, CN II-XII intact, motor and sensory \nfunction grossly intact\nSkin: Has left arm \nAccess: Midline', 'diagnoses': [{'icd_code': 'K7460', 'desc': 'Unspecified cirrhosis of liver'}, {'icd_code': 'E43', 'desc': 'Unspecified severe protein-calorie malnutrition'}, {'icd_code': 'K652', 'desc': 'Spontaneous bacterial peritonitis'}, {'icd_code': 'A419', 'desc': 'Sepsis, unspecified organism'}, {'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'R6521', 'desc': 'Severe sepsis with septic shock'}, {'icd_code': 'K7200', 'desc': 'Acute and subacute hepatic failure without coma'}, {'icd_code': 'R188', 'desc': 'Other ascites'}, {'icd_code': 'K766', 'desc': 'Portal hypertension'}, {'icd_code': 'K56699', 'desc': 'Other intestinal obstruction unspecified as to partial versus complete obstruction'}, {'icd_code': 'T8140XA', 'desc': 'Infection following a procedure, unspecified, initial encounter'}, {'icd_code': 'N400', 'desc': 'Benign prostatic hyperplasia without lower urinary tract symptoms'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'F259', 'desc': 'Schizoaffective disorder, unspecified'}, {'icd_code': 'K3189', 'desc': 'Other diseases of stomach and duodenum'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'K743', 'desc': 'Primary biliary cirrhosis'}, {'icd_code': 'Z515', 'desc': 'Encounter for palliative care'}, {'icd_code': 'E8770', 'desc': 'Fluid overload, unspecified'}, {'icd_code': 'R8271', 'desc': 'Bacteriuria'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'Z6821', 'desc': 'Body mass index [BMI] 21.0-21.9, adult'}], 'summary': "ADMISSION LABS:\n===============\n___ 11:10AM BLOOD WBC-65.5*# RBC-3.66* Hgb-10.2* Hct-31.1* \nMCV-85 MCH-27.9 MCHC-32.8 RDW-18.6* RDWSD-45.8 Plt ___\n___ 11:10AM BLOOD Neuts-95* Bands-3 Lymphs-1* Monos-1* \nEos-0 Baso-0 ___ Myelos-0 AbsNeut-64.19* \nAbsLymp-0.66* AbsMono-0.66 AbsEos-0.00* AbsBaso-0.00*\n___ 11:10AM BLOOD UreaN-46* Creat-2.2* Na-129* K-4.8 Cl-88* \nHCO3-17* AnGap-29*\n___ 11:10AM BLOOD ALT-13 AST-16 AlkPhos-98 TotBili-0.9\n___ 11:10AM BLOOD Calcium-8.7 Phos-5.6* Mg-1.6\n\nIMPORTANT LABS:\n===============\n___ 07:22AM BLOOD TSH-9.4*\n___ 07:22AM BLOOD T4-8.2\n___ 03:42AM URINE Color-Red Appear-Cloudy Sp ___\n___ 03:42AM URINE Blood-MOD Nitrite-POS Protein->600 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.5* Leuks-LG\n___ 03:42AM URINE RBC->182* WBC-37* Bacteri-MANY Yeast-NONE \nEpi-0\n\nMICRO LABS:\n===========\nURINE CULTURE (Final ___: MIXED BACTERIAL FLORA ( >= 3 \nCOLONY TYPES), CONSISTENT WITH FECAL CONTAMINATION. \n\nDISCHARGE LABS:\n===============\n___ 05:32AM BLOOD WBC-91.2* RBC-2.74* Hgb-7.6* Hct-23.4* \nMCV-85 MCH-27.7 MCHC-32.5 RDW-19.5* RDWSD-49.1* Plt Ct-62*\n___ 05:32AM BLOOD Glucose-133* UreaN-41* Creat-1.4* Na-131* \nK-3.5 Cl-98 HCO3-24 AnGap-13\n___ 05:32AM BLOOD Calcium-8.4 Phos-3.6 Mg-2.1\n\nIMPORTANT IMAGES/STUDIES:\n=========================\nCT chest w/o contrast (___): 1. Interval decrease in size of \nthe confluent right paratracheal lymph node conglomerate with \nless mass effect on the upper trachea. Encasement of the \nbrachiocephalic artery, brachiocephalic vein, and SVC and \ncontact with the right main pulmonary artery are unchanged, \nwhile sequelae of venous outflow\nobstruction have progressed. 2. Previously seen 8 mm right lower \nlobe pulmonary nodule is no longer present. 3. Interval increase \nin pleural effusions, small to moderate on the right and small \non the left. 4. Please see separately submitted Abdomen and \nPelvis CT report for subdiaphragmatic findings and neck CT \nreport for findings above the thoracic\ninlet.\n\nCT neck w/o contrast (___): 1. Dental amalgam streak artifact \nand patient body habitus limits study. 2. Within limits of \nstudy, no definite evidence of cervical mass. 3. Partially \nvisualized pretracheal probable lymphadenopathy, better \nvisualized on concurrently obtained chest CT. 4. Scattered \nnonspecific bilateral cervical mildly prominent lymph nodes, \nwithout definite enlargement by CT size criteria. 5. Moderate \ncervical degenerative changes as described, most severe at \nC6-C7, where there is moderate vertebral canal narrowing. If \nclinically indicated, consider dedicated cervical spine MRI for \nfurther evaluation. 6. Please note that artifact limits \nevaluation of T1 vertebral body. If\nclinically indicated, consider dedicated thoracic spine imaging \nfor further evaluation. 7. Right-sided pleural effusion. Please \nsee concurrently obtained noncontrast chest CT for description \nof thoracic structures.\n\nCT abdomen/pelvis w/o contrast (___): 1. No findings to \nexplain the patient's nausea. 2. No interval evidence for \ndisease recurrence or metastases.\n___ year old male with bladder cancer (C3D10 of Gemcitabine - \nCisplatin) with past medical history of chronic kidney disease, \natrial fibrillation (on xeralto), hyperlipidemia, who presents \nwith nausea and vomiting with inability to take any of his \nmedications.\n\nHis nausea and vomiting was likely chemotherapy related as there \nwere no signs of infection or sick contacts. He was given reglan \nwith marked improvement in his nausea. Because he was nauseous, \nhe was unable to take his metoprolol at home and he presented \nwith atrial fibrillation with RVR (140s-160s). His metoprolol \nwas fractionated and he was given IV pushes of extra metoprolol, \nbut eventually he was found to respond to diltiazem and he will \ngo home with diltiazem 120 mg ER in addition to his normal \nmetoprolol dose. Once he was able to take PO, he was continued \non his home xerelto for anticoagulation (this was adjusted \ninitially for his ___. For his ___ (Cr 2.2 on admission) and \nhyponatremia (129), he was given multiple boluses of LR with \nimprovement (thought to be secondary to volume depletion). For \nhis bladder cancer, he received a CT neck/torso without contrast \n(___) that showed no interval progression of disease. He also \nhad leukocytosis that persistent throughout the hospital \nadmission (~40s-70s) which is likely related to recent neulasta \nuse. He also had thrombocytopenia and anemia, thought to be \nsecondary to his chemotherapy.\n\n#Nausea/Vomiting: This was thought to be likely chemotherapy \nrelated as there were no signs of infection or sick contacts. He \nwas given multiple boluses of LR (___) and started on a nausea \nregimen that included zofran, reglan, and ativan. The reglan \nworked best for him, so he was discharged on this (10 mg), which \nhe will take TID with meals and use zofran for breakthrough.\n\n#Atrial fibrillation with rapid ventricular response: He is on \nxeralto 20 mg qd and metoprolol XL 200 mg qd at home, but he was \nunable to take these a few days prior to presenting to the \nhospital secondary to nausea and vomiting. Once his nausea and \nvomiting were well-controlled, he was started on fractionated \nmetoprolol with IV pushes of dilt and metop for HR ~140s. He was \nthen started on diltiazem 30 mg q6h, which was switched to ___ \n120 mg qd upon discharge with HR ~80s-100s. He will follow-up \nwith Dr. ___ in early ___ regarding his \nrate control as well as using xerelto in the setting of \nthrombocytopenia (CHADS = 2).\n\n#Acute on chronic kidney disease: His creatinine normally is \n1.3-1.6, but it was 1.9 on admission. This was likely secondary \nto poor PO intake, as it improved to 1.5 on discharge with IVF \nand improvement of his nausea and PO intake.\n\n#Bladder cancer: On admission he was on C3D10 of gem/cit. A CT \nneck/torso w/o contrast (___) showed no interval progression \nof disease. We were trying to arrange a port placement while he \nwas in-patient, but since his xerelto had to be held for 48 \nhours, he would of had to stay here until the weekend. He will \nget the port placed as an outpatient instead.\n\n#Left arm infiltrate: Apparently the patient had an IV \ninfiltrate while in chemo a month ago and has since had skin \npigmentation and texture changes and tenderness to palpation. It \ndoes not look acutely concerning for cellulitis and the patient \nstates that it is improving.\n\n#Hyponatremia: Patient has had this intermittently chronically. \nThis is likely related to poor PO intake as it responded to IVF.\n\n#Leukocytosis: This is likely related to neulasta. No other \nconcerning signs or symptoms of acute infection.\n\n#Hyperlipidemia: He was continued on his home pravastatin 40 mg \nPO QPM when able to take POs\n\n#History of diabetes: Has not had since he lost a significant \namount of weight. He was kept on a low dose sliding scale \ninsulin while in-patient.\n\n#Depression: He takes celexa 20 mg qd at home. However, as there \nis a risk for serotonin syndrome when this is taken along with \nreglan, this was discontinued upon discharge. He was told to \ncall his PCP or oncologist if he starts to notice worsening \nsigns or symptoms of depression, suicidal ideation, \nhopelessness, anhedonia, or feelings of guilt."}}
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{'final_diagnoses': ['Nausea', 'Bladder cancer', 'Atrial fibrillation with rapid ventricular response', 'Acute on chronic kidney disease', 'Hyponatremia', 'Leukocytosis', 'Hyperlipidemia', 'Anemia', 'Thrombocytopenia'], 'procedures': ['None'], 'visit_summary': '___ year old male with bladder cancer (C3D10 of Gemcitabine - \nCisplatin) with past medical history of chronic kidney disease, \natrial fibrillation (on xeralto), hyperlipidemia, who presents \nwith nausea and vomiting with inability to take any of his \nmedications.\n\nHis nausea and vomiting was likely chemotherapy related as there \nwere no signs of infection or sick contacts. He was given reglan \nwith marked improvement in his nausea. Because he was nauseous, \nhe was unable to take his metoprolol at home and he presented \nwith atrial fibrillation with RVR (140s-160s). His metoprolol \nwas fractionated and he was given IV pushes of extra metoprolol, \nbut eventually he was found to respond to diltiazem and he will \ngo home with diltiazem 120 mg ER in addition to his normal \nmetoprolol dose. Once he was able to take PO, he was continued \non his home xerelto for anticoagulation (this was adjusted \ninitially for his ___. For his ___ (Cr 2.2 on admission) and \nhyponatremia (129), he was given multiple boluses of LR with \nimprovement (thought to be secondary to volume depletion). For \nhis bladder cancer, he received a CT neck/torso without contrast \n(___) that showed no interval progression of disease. He also \nhad leukocytosis that persistent throughout the hospital \nadmission (~40s-70s) which is likely related to recent neulasta \nuse. He also had thrombocytopenia and anemia, thought to be \nsecondary to his chemotherapy.\n\n#Nausea/Vomiting: This was thought to be likely chemotherapy \nrelated as there were no signs of infection or sick contacts. He \nwas given multiple boluses of LR (___) and started on a nausea \nregimen that included zofran, reglan, and ativan. The reglan \nworked best for him, so he was discharged on this (10 mg), which \nhe will take TID with meals and use zofran for breakthrough.\n\n#Atrial fibrillation with rapid ventricular response: He is on \nxeralto 20 mg qd and metoprolol XL 200 mg qd at home, but he was \nunable to take these a few days prior to presenting to the \nhospital secondary to nausea and vomiting. Once his nausea and \nvomiting were well-controlled, he was started on fractionated \nmetoprolol with IV pushes of dilt and metop for HR ~140s. He was \nthen started on diltiazem 30 mg q6h, which was switched to ___ \n120 mg qd upon discharge with HR ~80s-100s. He will follow-up \nwith Dr. ___ in early ___ regarding his \nrate control as well as using xerelto in the setting of \nthrombocytopenia (CHADS = 2).\n\n#Acute on chronic kidney disease: His creatinine normally is \n1.3-1.6, but it was 1.9 on admission. This was likely secondary \nto poor PO intake, as it improved to 1.5 on discharge with IVF \nand improvement of his nausea and PO intake.\n\n#Bladder cancer: On admission he was on C3D10 of gem/cit. A CT \nneck/torso w/o contrast (___) showed no interval progression \nof disease. We were trying to arrange a port placement while he \nwas in-patient, but since his xerelto had to be held for 48 \nhours, he would of had to stay here until the weekend. He will \nget the port placed as an outpatient instead.\n\n#Left arm infiltrate: Apparently the patient had an IV \ninfiltrate while in chemo a month ago and has since had skin \npigmentation and texture changes and tenderness to palpation. It \ndoes not look acutely concerning for cellulitis and the patient \nstates that it is improving.\n\n#Hyponatremia: Patient has had this intermittently chronically. \nThis is likely related to poor PO intake as it responded to IVF.\n\n#Leukocytosis: This is likely related to neulasta. No other \nconcerning signs or symptoms of acute infection.\n\n#Hyperlipidemia: He was continued on his home pravastatin 40 mg \nPO QPM when able to take POs\n\n#History of diabetes: Has not had since he lost a significant \namount of weight. He was kept on a low dose sliding scale \ninsulin while in-patient.\n\n#Depression: He takes celexa 20 mg qd at home. However, as there \nis a risk for serotonin syndrome when this is taken along with \nreglan, this was discontinued upon discharge. He was told to \ncall his PCP or oncologist if he starts to notice worsening \nsigns or symptoms of depression, suicidal ideation, \nhopelessness, anhedonia, or feelings of guilt.', 'medications_prescribed': ['Diltiazem Extended-Release 120 mg PO DAILY \nRX *diltiazem HCl [Cardizem CD] 120 mg 1 capsule(s) by mouth \ndaily Disp #*30 Capsule Refills:*0', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice \na day Disp #*60 Capsule Refills:*0', 'Metoclopramide 10 mg PO TID before meals \nRX *metoclopramide HCl 10 mg 1 tablet by mouth three times a day \nDisp #*90 Tablet Refills:*0', 'Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN rectal \nirritaiton', 'Levothyroxine Sodium 75 mcg PO DAILY', 'LORazepam 0.5 mg PO BID:PRN nausea', 'Magnesium Oxide 800 mg PO DAILY', 'Metoprolol Succinate XL 200 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Ondansetron 8 mg PO Q8H:PRN nasuea', 'Pravastatin 40 mg PO QPM', 'Rivaroxaban 20 mg PO DAILY', 'Outpatient Physical Therapy\nDx: Left arm lymphedema I___.0\n___: Ongoing\nPhysical therapy', 'Rolling walker\nDx: Bladder cancer C___\nPx: Good\n___: 13 months']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'bicycle accident', 'medical_history': ['HIV - not on therapy. States he has been "fine" He has had HIV\nsince age ___', 'HCV'], 'family_history': 'NC', 'present_illness': 'This patient is a ___ year old male who complains of a bicycle \naccident. The patient is transferred from OSH where he was an \nintoxicated bicyclist struck by motor vehicle. Unknown speed, \nwhether helmeted, or whether LOC. he was reportedly\nriding erratically prior to the event. He had pan-CT scan at OSH \nwhich showed multiple facial fractures as well as a R PTX, chest \ntube placed at the OSH. Patient was combative and received a \ntotal of 6mg morphine and 3 mg ativan.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 168.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '281', 'valuenum': 281.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.3', 'valuenum': 41.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '256', 'valuenum': 256.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '260', 'valuenum': 260.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission PHYSICAL EXAMINATION: ___\n \nConstitutional: Altered, GCS 13\nHEENT: Pupils equal, round and reactive to light,\nExtraocular muscles intact grossly though patient poorly\ncompliant with exam. L sided periorbital ecchymosis.\nChest: Clear to auscultation\nCardiovascular: Regular Rate and Rhythm\nAbdominal: Soft, Nontender\nGU/Flank: No costovertebral angle tenderness\nExtr/Back: No cyanosis, clubbing or edema\nSkin: No rash\nNeuro: Speech fluent\nPsych: Normal mood\n\nDischarge PE: ___\nGeneral: NAD\nLungs: LSCTAB, diminished at the bases\nCV: RRR, no mumurs, rubs or gallops\nAbd: Soft, nontender non distended\nExtrm: warm well perfused, L knee abrasion without edema, full \nROM\nNeuro: Alert and oriented X3, MAE to command, PERRL', 'diagnoses': [{'icd_code': 'M170', 'desc': 'Bilateral primary osteoarthritis of knee'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6832', 'desc': 'Body mass index [BMI] 32.0-32.9, adult'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'G8918', 'desc': 'Other acute postprocedural pain'}, {'icd_code': 'R110', 'desc': 'Nausea'}, {'icd_code': 'I9581', 'desc': 'Postprocedural hypotension'}], 'summary': '___ 08:00AM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS \ncocaine-POS amphetmn-NEG mthdone-NEG\n___ 08:00AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 08:00AM URINE RBC-0 WBC-<1 BACTERIA-FEW YEAST-NONE \nEPI-0\n___ 08:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 06:24AM GLUCOSE-103 LACTATE-1.5 NA+-142 K+-4.2 \nCL--101 TCO2-26\n___ 06:15AM UREA N-9 CREAT-0.7\n___ 06:15AM ASA-NEG ETHANOL-64* ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 06:15AM WBC-9.5 RBC-5.24 HGB-14.9 HCT-46.7 MCV-89 \nMCH-28.5 MCHC-31.9 RDW-13.9\n___ 06:15AM PLT COUNT-226\n___ 06:15AM ___ PTT-31.6 ___\n___ 07:05AM BLOOD WBC-7.8 RBC-5.39 Hgb-15.0 Hct-47.8 MCV-89 \nMCH-27.9 MCHC-31.4 RDW-13.8 Plt ___\n___ 07:05AM BLOOD ___ PTT-33.3 ___\n\n___: CXR: 1. Chest tube in appropriate position with small \nright-sided pneumothorax.\n2. Increased opacities at the mid right lung is likely secondary \nto\naspiration. Continued close interval follow up is recommended.\n\n___: TIB/FIB XRAY: 1. Linear density along the posterior \nmargin of the tibia may be secondary to an old trauma. No \ndefinite acute fracture is identified. \n2. Irregularity along the lateral cortex of the distal tibia is \nincompletely evaluated on this exam, however also likely \nsecondary to an old trauma\n\n___: CXR: (CT to water seal) Stable small right pneumothorax\nIncreased bibasilar opacities could be due to atelectasis and or \naspiration\nMr. ___ is a ___ year old man with a past medical history \nsignificant for HIV, HCV, and polysubstance abuse who was \nadmitted to ___ from an OSH after he was hit by a car while \nriding his bike intoxicated. At the ___ hospital he was found to \nhave a right pneumothorax for which a chest tube was placed, \nfacial fractures and he was transferred to ___. His injuries \ninclude right sided tension pneumothorax, left lateral orbital \nwall fracture, left zygomatic fracture, nasal bone fractures, \nand a left maxillary sinus fracture. He was evaluated by \nplastic surgery and it was decided that operative management was \nwould not be preformed on this admission. Opthalmology \nevaluated patient and deemed no intervention needed. Tertiary \nsurvey was negative for further injury. \nHe was admitted to the general care floor and remained \nhemodynamically stable. He was placed on a CIWA scale for \nalcohol withdrawal. He was placed on a soft diet and sinus \nprecautions. On ___, the right chest tube was placed to water \nseal; subsequent Chest X-Ray revealed increased pneumothorax. \nThus, it was placed back to suction for 24 hours. Chest X-Ray on \n___, showed small right pneumothorax and it placed back water \nseal. On ___, the Chest X-Ray was stable and his Chest tube was \ndiscontinued. A post pull film was stable small apical \npneumothorax. \n\nHe was discharged on ___ hemodynamically stable without an \noxygen requirement. His pain was well controlled with oral \nDilaudid. He was ambulating independently. He remained afebrile \nwith a normal WBC. He was evaluated by social work and given an \nappointment for substance abuse follow up. Occupational Therapy \nsaw patient for cognitive evaluation and concussive symptom \neducation. He will see Plastic surgery and the ___ clinic as \nlisted below. The patient was educated on discharge instructions \nand stated good understanding of the discharge care plan. ___ \nwill evaluate him for medication review and home safety.'}}
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{'final_diagnoses': ['polytrauma'], 'procedures': ['none'], 'visit_summary': 'Mr. ___ is a ___ year old man with a past medical history \nsignificant for HIV, HCV, and polysubstance abuse who was \nadmitted to ___ from an OSH after he was hit by a car while \nriding his bike intoxicated. At the ___ hospital he was found to \nhave a right pneumothorax for which a chest tube was placed, \nfacial fractures and he was transferred to ___. His injuries \ninclude right sided tension pneumothorax, left lateral orbital \nwall fracture, left zygomatic fracture, nasal bone fractures, \nand a left maxillary sinus fracture. He was evaluated by \nplastic surgery and it was decided that operative management was \nwould not be preformed on this admission. Opthalmology \nevaluated patient and deemed no intervention needed. Tertiary \nsurvey was negative for further injury. \nHe was admitted to the general care floor and remained \nhemodynamically stable. He was placed on a CIWA scale for \nalcohol withdrawal. He was placed on a soft diet and sinus \nprecautions. On ___, the right chest tube was placed to water \nseal; subsequent Chest X-Ray revealed increased pneumothorax. \nThus, it was placed back to suction for 24 hours. Chest X-Ray on \n___, showed small right pneumothorax and it placed back water \nseal. On ___, the Chest X-Ray was stable and his Chest tube was \ndiscontinued. A post pull film was stable small apical \npneumothorax. \n\nHe was discharged on ___ hemodynamically stable without an \noxygen requirement. His pain was well controlled with oral \nDilaudid. He was ambulating independently. He remained afebrile \nwith a normal WBC. He was evaluated by social work and given an \nappointment for substance abuse follow up. Occupational Therapy \nsaw patient for cognitive evaluation and concussive symptom \neducation. He will see Plastic surgery and the ___ clinic as \nlisted below. The patient was educated on discharge instructions \nand stated good understanding of the discharge care plan. ___ \nwill evaluate him for medication review and home safety.', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q6H \nDo not exceed 3 grams per day. ', '2. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nDo not drive or drink alcohol while on this medication. \nRX *hydromorphone 2 mg ___ tablet(s) by mouth every four (4) \nhours Disp #*40 Tablet Refills:*0', '3. Ibuprofen 400 mg PO Q8H ', '4. Docusate Sodium 100 mg PO BID \nRX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice \na day Disp #*30 Capsule Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ['CKD, Stage IV, baseline Cr ___', 'Chronic atrial fibrillation on anti-coagulation', 'HTN', 'Diastolic dysfunction, mild systolic dysfunction', 'Rheumatic heart disease involving mitral valve with subsequent \nmild MS and 2+ MR, AI', 'Hypothyroidism', 'Pulmonary Hypertension (TR gradient 61 on TTE in ___'], 'family_history': 'Mother died traumatically at age ___. Father died of stomach \ncancer at age ___. No brothers or sisters.', 'present_illness': '___ yo F presents w/ 6 day hx of RUQ pain. Patient reports sharp,\nintermittent pain following meals. Pain does not radiate. Pain\nhas become progressively worse, and is currently ___. Reports\nnausea and ___ episodes/day of non-bloody emesis following \nmeals.\nDenies episodes of subjective fever. Reports chills as well as\n___ episodes of non-bloody diarrhea/day since ___. Denies\nSOB, chest-pain, dysuria, or urinary urgency.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nystatin Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'POS', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '412', 'valuenum': 412.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 178.0, 'flag': None, 'priority': 'STAT', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '317', 'valuenum': 317.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '262', 'valuenum': 262.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'T: 101.3 HR:82 BP:154/86 RR:18 O2:100%RA\nGEN: A&Ox3, NAD \nHEENT: MMM \nCV: RRR, No M/G/R \nPULM: \nABD: Soft, ND, RUQ tenderness. BS+. ___ sign. \nExt: Calves soft, 1+ edema bilateral', 'diagnoses': [{'icd_code': '78650', 'desc': 'Chest pain, unspecified'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}], 'summary': "___ 12:18AM WBC-11.5* RBC-3.38* HGB-9.0* HCT-27.3* \nMCV-81* MCH-26.7* MCHC-33.1 RDW-14.7\n___ 12:18AM NEUTS-79.8* LYMPHS-15.5* MONOS-4.2 EOS-0.1 \nBASOS-0.5\n___ 12:18AM PLT COUNT-230\n___ 12:18AM ___ PTT-49.5* ___\n___ 12:18AM ALT(SGPT)-52* AST(SGOT)-70* ALK PHOS-203* TOT \nBILI-1.3\n___ 12:18AM GLUCOSE-97 UREA N-53* CREAT-2.7* SODIUM-140 \nPOTASSIUM-3.9 CHLORIDE-106 TOTAL CO2-21* ANION GAP-17\n\n___ CT Abd/pelvis :\n1. Acute cholecystitis, with possible gangrenous component. \nPlease refer to subsequent ultrasound for further details. \n2. Moderate cardiomegaly, with right-sided volume overload. \n3. Small paraesophageal hiatal hernia. \n4. Severe atherosclerosis \n5. Bilateral renal atrophy. \n\n___ Liver US :\n1. Findings consistent with acute cholecystitis. In addition, \ngallbladder \nwall irregularity and probable internal hemorrhage raise the \npossibility of gangrenous cholecystitis. \n2. Mild intrahepatic biliary dilatation and apparent tapering of \nthe common duct to the level of an impacted stone at the \ngallbladder neck, suggestive of Mirizzi syndrome. Please \ncorrelate clinically. \n\n___ Percutaneous cholecystotomy drainage :\nUncomplicated percutaneous cholecystostomy tube placement. A \nsmall sample was sent for microbiological analysis. \n The catheter should remain in place for minimum of three to \nfour weeks and depending on patient's clinical recovery, a tube \ncholangiogram can be \nperformed to ensure cystic duct patency prior to tube removal. \nPlease note \nthat the gallsones will not be removed by catheter drainage. \n \n\n___ 3:20 am BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: \n ESCHERICHIA COLI. FINAL SENSITIVITIES. \n Piperacillin/Tazobactam sensitivity testing confirmed \nby ___\n ___. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n ESCHERICHIA COLI\n | \nAMPICILLIN------------ =>32 R\nAMPICILLIN/SULBACTAM-- 16 I\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM NEGATIVE ROD(S). \n\n___ 3:30 am BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\n___ 10:00 am BILE\n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n 2+ ___ per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n FLUID CULTURE (Final ___: \n ESCHERICHIA COLI. RARE GROWTH. \n Piperacillin/tazobactam sensitivity testing available \non request. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n ESCHERICHIA COLI\n | \nAMPICILLIN------------ =>32 R\nAMPICILLIN/SULBACTAM-- =>32 R\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED.\nMrs. ___ was evaluated by the Acute Care service in the \nEmergency Room and based on her physical exam and liver \nultrasound she was admitted to the hospital with acute \ncholecystitis. She was made NPO, hydrated with IV fluids and \nplaced on broad spectrum antibiotics. Plans were for a \npercutaneous cholecystotomy tube to be placed for drainage with \ncholecystectomy to be arranged at a later date. Unfortunately \nher INR on admission was 7.3 and she required a plasma \ntransfusion and Vitamin K to help decrease her INR prior to the \nplanned procedure.\n\nOn ___ her INR was down to 1.7 and she subsequently \nunderwent a percutaneous cholecystotomy tube placement. She \ntolerated the procedure well and returned to the Surgical floor \nwhere she continued to make good progress. Her WBC dropped from \n18K to 9K within 24 hours and she was pain free and without \nfevers. She began a liquid diet and was gradually increased to \nregular which she tolerated well. Her Coumadin was restarted \npost procedure.\n\nBlood cultures done on admission grew E Coli out of one bottle \n(___) and the bile culture grew Ecoli as well, sensitive to \nCiprofloxacin. She will continue on oral Ciprofloxacin thru \n___. A stool for C diff colitis was done as she had an \nepisode of diarrhea which was guiac positive. The stool \nspecimen was negative for C diff and her diarrhea resolved.\n\nShe was evaluated by the Physical Therapy service to assure safe \ntransition home and she was able to walk independently however \nwas deconditioned. With increasing her mobility in the hospital \nthey anticipate she will be back to baseline in a week. She \nwill have a home safety evaluation upon discharge.\n\nHer INR at discharge is 3.0 which reflects her usual dose of \nCoumadin 5mg daily which was started on ___. Due to \nantibiotic therapy and dietary changes she will omit her \nCoumadin today, restart ___ at 2.5 mg daily and go back to \nher usual dose on ___. The ___ here will \ncontinue to regulate her doses and her blood is drawn every \n___ by the ___.\n\nMrs. ___ was discharged to home on ___ with ___ services to \nhelp with her abdominal drain. She will return to the ___ \n___ in 2 weeks for re evaluation."}}
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{'final_diagnoses': ['Acute cholecystitis', 'E Coli bacteremia'], 'procedures': ['Percutaneous cholecystotomy tube placement'], 'visit_summary': 'Mrs. ___ was evaluated by the Acute Care service in the \nEmergency Room and based on her physical exam and liver \nultrasound she was admitted to the hospital with acute \ncholecystitis. She was made NPO, hydrated with IV fluids and \nplaced on broad spectrum antibiotics. Plans were for a \npercutaneous cholecystotomy tube to be placed for drainage with \ncholecystectomy to be arranged at a later date. Unfortunately \nher INR on admission was 7.3 and she required a plasma \ntransfusion and Vitamin K to help decrease her INR prior to the \nplanned procedure.\n\nOn ___ her INR was down to 1.7 and she subsequently \nunderwent a percutaneous cholecystotomy tube placement. She \ntolerated the procedure well and returned to the Surgical floor \nwhere she continued to make good progress. Her WBC dropped from \n18K to 9K within 24 hours and she was pain free and without \nfevers. She began a liquid diet and was gradually increased to \nregular which she tolerated well. Her Coumadin was restarted \npost procedure.\n\nBlood cultures done on admission grew E Coli out of one bottle \n(___) and the bile culture grew Ecoli as well, sensitive to \nCiprofloxacin. She will continue on oral Ciprofloxacin thru \n___. A stool for C diff colitis was done as she had an \nepisode of diarrhea which was guiac positive. The stool \nspecimen was negative for C diff and her diarrhea resolved.\n\nShe was evaluated by the Physical Therapy service to assure safe \ntransition home and she was able to walk independently however \nwas deconditioned. With increasing her mobility in the hospital \nthey anticipate she will be back to baseline in a week. She \nwill have a home safety evaluation upon discharge.\n\nHer INR at discharge is 3.0 which reflects her usual dose of \nCoumadin 5mg daily which was started on ___. Due to \nantibiotic therapy and dietary changes she will omit her \nCoumadin today, restart ___ at 2.5 mg daily and go back to \nher usual dose on ___. The ___ here will \ncontinue to regulate her doses and her blood is drawn every \n___ by the ___.\n\nMrs. ___ was discharged to home on ___ with ___ services to \nhelp with her abdominal drain. She will return to the ___ \n___ in 2 weeks for re evaluation.', 'medications_prescribed': ['1. diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO DAILY (Daily). ', '2. carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day). ', '3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '4. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '5. metolazone 2.5 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '6. Hectorol 2.5 mcg Capsule Sig: One (1) Capsule PO every \n___. ', '7. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO once a \nweek. ', '8. Aranesp (polysorbate) 60 mcg/0.3 mL Syringe Sig: One (1) \ninjection Injection once a month. ', '9. Combivent ___ mcg/Actuation Aerosol Sig: One (1) puff \nInhalation four times a day as needed for shortness of breath or \nwheezing. ', '10. losartan 100 mg Tablet Sig: One (1) Tablet PO once a day. ', '11. Coumadin 5 mg Tablet Sig: ___ Tablet PO once a day: start \n___ then begin your usual dose ___. ', '12. ciprofloxacin 500 mg Tablet Sig: 1.5 Tablets PO Q24H (every \n24 hours): thru ___.Disp:*20 Tablet(s)* Refills:*0*', '13. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO twice a day.\nDisp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 29, 'gender': 'M', 'symptoms': 'Weakness, cough', 'medical_history': ['Cardiac & Vascular History:', '- HFrEF / Ischemic Cardiomyopathy (EF ___', '- Coronary artery disease status post stenting of the RI with\n3.0x13 mm Tetra stent and the OM2 with a 2.5 x 13 Tetra stent in\n___ with a repeat catheterization in ___ showing proximal LAD\nwith 50% stenosis', '- Chronic atrial fibrillation/flutter on apixiban. She underwent\nunsuccessful DCCV on ___.', '- Peripheral arterial disease with right femoral and retroaortic\nleft iliac bypass grafting as part of her renal transplant\nsurgery in ___. The graft is located in the left lower \nquadrant.', '- HTN', '- HLD', 'Other PMH:', '- CKD s/p two renal transplants for IgA nephropathy, most\nrecently in ___.', '- ___ liver fibrosis/early cirrhosis with peripheral edema and\nascites managed with diuretics', '- Diabetes, not insulin dependent', '- pancreatic cysts', '- history of positional vertigo', '- history of pachymeningitis', '- Syncope associated with lying on her left side'], 'family_history': 'Mother died at age ___ of CAD and Diabetes. Father died at age \n___ of kidney cancer. He had an MI in his ___. Maternal aunt and\nfirst cousin with thyroid cancer. MGF had MI in ___.', 'present_illness': "Ms ___ is a ___ yo F with history of ischemic cardiomyopathy\n(EF ___, atrial fibrillation (on apixaban), CKD ___ IgA\nnephropathy s/p 2 renal transplants (most recent ___, and NASH\ncirrhosis who presented to the ED on ___ with weakness and\nconfusion. Per patient's husband she was having worsening cough\nover the last several days and generalized weakness. She was\nfeeling generally well on ___, then on ___ night she\nacutely became weak. On ___ she continued to have weakness \nand\nconfusion. She reported chest pain as well, she took SL Nitro x2\nprior to admission. She was brought to the ED by ambulance given\ngeneral decline.\n\nIn the ED, initial VS were: 96.9 102 111/66 18 99% RA. She\nreceived Lasix 80mg IV with subsequent hypotension to 90's.\nInitial labs notable for ___ 26065, Trop-T 0.06, Lactate 2.9.\nShe had a CXR with RLL pneumonia and a negative CT head. She\nreceived Vancomycin and Cefepime.\n\nShe was admitted to medicine overnight on ___ and was given\n500cc. She was continued on Vanc/Cefepime/Azithro for pneumonia\ncoverage. Her mental status and fatigue improved on ___ with\ntreatment of pneumonia. She did not receive IV fluids or \ndiuresis\non ___. \n\nOn the morning of ___ she became acutely altered. She was only\nanswering yes to some questions. She had mild respiratory\ndistress with labored breathing. Her vitals remained stable with\nT99.8, BP 114 / 82, HR 106, RR 14, O2 95 Ra. Exam with\nsignificant lower extremity edema and ascites although stable\nfrom day prior. Her labs notable for pH 7.54, pCOs 14, lactate\n4.7, Cr 1.7 from 1.1, ALT 1367, AST 2306, LDH 3685. Troponin .05\n(from .06 on admission). EKG with LBBB stable from prior. Her \nCXR\nshowed vascular congestion and LLL infiltrate (CXR on admission\nwith ?R sided pneumonia). TTE with EF ___ and akinesis of the\ninferior and inferolateral walls which is new from prior (last\nTTE ___ with EF ___. She received Lasix 80mg with minimal\noutput then 160mg at 1000. She was started on Nitro for\npreload/afterload reduction. Cardiology was consulted given\nconcern for cardiogenic shock and was transferred to CCU for\nfurther management.\n\nOf note patient has been hospitalized approximately 6 times in\nthe last year and intermittently has decline in her mental\nstatus. She was most recently admitted ___ for altered \nmental\nstatus and lactic acidosis which was thought to be\nmultifactorial. Hepatic \nencephalopathy felt less likely given normal ammonia level, no \nasterixis on exam and no improvement with empiric trial of \nlactulose. Palliative care was consulted to begin goals of care\ndiscussions if functional status does not improve. DNR/DNI code\nstatus\nconfirmed and patient discharged with MOLST paperwork. \n\n On arrival to the CCU, patient is denying pain. She reports she\nis at ___ and knows the year but is not responding to other\nquestions. Her history was confirmed with her husband who is\npresent at bedside.", 'medications': [{'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Colchicine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Colchicine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 1.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '___', 'valuenum': 251.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.37, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 181.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.31, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.45, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.9', 'valuenum': 40.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.55', 'valuenum': 4.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.81, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.5', 'valuenum': 41.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '216', 'valuenum': 216.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.66', 'valuenum': 4.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nVS: 97.7 111 / 70 85 18 95 Ra \nWeight: 118 lbs\nGENERAL: Chronically ill appearing patient, lying in hospital\nbed, no acute distress, appears very tired and weak \nHEENT: Mouth appears dry \nNECK: JVP noted at 6 cm above clavicle \nHEART: Irregularly irregular, no m/r/g \nLUNGS: Breathing comfortably w/o use of accessory muscles,\ncrackles bases noted on the L base \nABDOMEN: NABS, distended, reducible hernia present, no pain with\npalpation in all four quadrants, no rebound or guarding\nEXTREMITIES: Warm and well perfused, 2+ pitting edema of the \nlegs\n\nDISCHARGE PHYSICAL EXAM:\n========================\nVS: Reviewed in ___\nGENERAL: Chronically ill appearing patient, lying in hospital\nbed, no acute distress, appears very tired and weak \nHEENT: Mouth appears dry \nNECK: JVP noted at 8 cm \nHEART: Irregularly irregular, axillary holosystolic murmur\nLUNGS: Breathing comfortably w/o use of accessory muscles,\ndiffuse coarse crackles bases noted bilaterally \nABDOMEN: NABS, distended, reducible hernia present, no pain with\npalpation in all four quadrants, no rebound or guarding\nEXTREMITIES: Warm and well perfused, 2+ pitting edema of the \nlegs', 'diagnoses': [{'icd_code': '42090', 'desc': 'Acute pericarditis, unspecified'}], 'summary': '=============== \nADMISSION LABS:\n=============== \n___ 08:10PM BLOOD WBC-3.6* RBC-4.33 Hgb-12.9 Hct-39.8 \nMCV-92 MCH-29.8 MCHC-32.4 RDW-24.5* RDWSD-78.6* Plt ___\n___ 08:10PM BLOOD Neuts-65.0 ___ Monos-11.3 \nEos-0.8* Baso-1.9* Im ___ AbsNeut-2.35 AbsLymp-0.74* \nAbsMono-0.41 AbsEos-0.03* AbsBaso-0.07\n___ 08:10PM BLOOD ___ PTT-29.1 ___\n___ 08:10PM BLOOD Glucose-170* UreaN-31* Creat-1.3* Na-134* \nK-5.0 Cl-91* HCO3-21* AnGap-22*\n___ 07:07PM BLOOD ALT-17 AST-43* AlkPhos-116* TotBili-0.6\n___ 07:07PM BLOOD ___\n___ 09:10PM BLOOD Lactate-2.9*\n\n=============== \nDISCHARGE LABS:\n=============== \nDischarged to hospice. Most recent labs:\n___ 05:45AM BLOOD WBC-5.2 RBC-3.46* Hgb-10.4* Hct-31.3* \nMCV-91 MCH-30.1 MCHC-33.2 RDW-23.3* RDWSD-75.8* Plt Ct-96*\n___ 05:45AM BLOOD Glucose-129* UreaN-53* Creat-2.0* Na-127* \nK-4.0 Cl-93* HCO3-16* AnGap-18\n___ 05:22AM BLOOD ALT-862* AST-513* AlkPhos-131* \nTotBili-0.7\n___ 05:45AM BLOOD Calcium-7.5* Phos-3.8 Mg-2.4\n___ 06:11AM BLOOD Lactate-1.3\n\n================ \nIMAGING STUDIES:\n================ \n___ CTH:\n \nIMPRESSION: \n \nNo acute intracranial abnormality. \n \n___ TTE:\nConclusions \n There is severe regional left ventricular systolic dysfunction \nwith akinesis of the inferior and inferolateral walls. There is \nsevere hypokinesis of the remaining segments (biplane LVEF 17%; \nvisual LVEF = ___ %). No masses or thrombi are seen in the \nleft ventricle. The remaining left ventricular segments are \nhypokinetic. The right ventricular cavity is mildly dilated with \nmild global free wall hypokinesis. Mild to moderate (___) \nmitral regurgitation is seen. There is mild pulmonary artery \nsystolic hypertension. There is no pericardial effusion. A left \npleural effusion is present. Ascites is present. \n\n___ RUQUS:\nIMPRESSION: \n \n \n1. Cirrhotic liver with small volume ascites. Patent portal \nveins with \nhepatopetal flow. \n2. Stable pancreatic cystic lesion better characterized on MRI. \n\n=============\nMICROBIOLOGY:\n=============\n___ 1:53 pm URINE Source: Catheter. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n__________________________________________________________\n___ 10:08 am STOOL CONSISTENCY: NOT APPLICABLE\n Source: Stool. \n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n CANCELLED. \n Test cancelled. Only one C. difficile test will \nnormally be\n performed per week. If clinically indicated, please \nresubmit a new\n specimen after a 7 day or greater interval has elapsed. \n\n Note, if there are compelling clinical reasons for \nrepeat testing\n within a seven day window (see discussion in ___ \nlaboratory\n manual), page the clinical microbiology resident on \ncall (pager\n ___ to discuss the need for this repeat testing. \n__________________________________________________________\n___ 9:00 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 8:05 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 5:13 pm Blood (EBV)\n\n **FINAL REPORT ___\n\n ___ VIRUS VCA-IgG AB (Final ___: \n TEST CANCELLED, PATIENT CREDITED. \n DUPLICATE SPECIMEN. \n\n ___ VIRUS EBNA IgG AB (Final ___: \n TEST CANCELLED, PATIENT CREDITED. \n DUPLICATE SPECIMEN. \n\n ___ VIRUS VCA-IgM AB (Final ___: \n TEST CANCELLED, PATIENT CREDITED. \n DUPLICATE SPECIMEN. \n__________________________________________________________\n___ 5:13 pm Blood (___ AB)\n\n **FINAL REPORT ___\n\n ___ IgG ANTIBODY (Final ___: \n POSITIVE FOR CMV IgG ANTIBODY BY EIA. \n 66 AU/ML. \n Reference Range: Negative < 4 AU/ml, Positive >= 6 AU/ml. \n\n\n CMV IgM ANTIBODY (Final ___: \n NEGATIVE FOR CMV IgM ANTIBODY BY EIA. \n INTERPRETATION: INFECTION AT UNDETERMINED TIME. \n A positive IgG result generally indicates past exposure. \n Infection with CMV once contracted remains latent and may \nreactivate\n when immunity is compromised Greatly elevated serum \nprotein with IgG\n levels ___ mg/dl may cause interference with CMV IgM \nresults. \n If current infection is suspected, submit follow-up serum \nin ___\n weeks. \n__________________________________________________________\n___ 4:30 pm MRSA SCREEN Source: Nasal swab. \n\n **FINAL REPORT ___\n\n MRSA SCREEN (Final ___: No MRSA isolated. \n__________________________________________________________\n___ 7:45 am Blood (EBV) ADDED HAP,LD,EBVP ___. \n\n **FINAL REPORT ___\n\n ___ VIRUS VCA-IgG AB (Final ___: POSITIVE \nBY EIA. \n\n ___ VIRUS EBNA IgG AB (Final ___: POSITIVE \nBY EIA. \n\n ___ VIRUS VCA-IgM AB (Final ___: \n NEGATIVE <1:10 BY IFA. \n INTERPRETATION: RESULTS INDICATIVE OF PAST EBV INFECTION. \n In most populations, 90% of adults have been infected at \nsometime\n with EBV and will have measurable VCA IgG and EBNA \nantibodies.\n Antibodies to EBNA develop ___ weeks after primary \ninfection and\n remain present for life. Presence of VCA IgM antibodies \nindicates\n recent primary infection. \n__________________________________________________________\n___ 7:45 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 8:00 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 9:26 pm STOOL CONSISTENCY: SOFT\n\n **FINAL REPORT ___\n\n OVA + PARASITES (Final ___: \n NO OVA AND PARASITES SEEN. \n This test does not reliably detect Cryptosporidium, \nCyclospora or\n Microsporidium. While most cases of Giardia are detected \nby routine\n O+P, the Giardia antigen test may enhance detection when \norganisms\n are rare. \n__________________________________________________________\n___ 9:04 pm STOOL CONSISTENCY: SOFT Source: Stool. \n\n\n **FINAL REPORT ___\n\n FECAL CULTURE (Final ___: NO SALMONELLA OR SHIGELLA \nFOUND. \n\n CAMPYLOBACTER CULTURE (Final ___: NO CAMPYLOBACTER \nFOUND. \n\n OVA + PARASITES (Final ___: \n CANCELLED. \n Three separate stool specimens collected EVERY OTHER \nDAY are\n recommended for optimum sensitivity. Duplicate \nspecimens collected\n on the same day will not be processed, since this does \nnot\n increase diagnostic yield. Make sure to label date and \ntime of\n collection on each stool specimen submitted to ensure \nappropriate\n processing. \n__________________________________________________________\n___ 9:04 pm STOOL CONSISTENCY: SOFT Source: Stool. \n\n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n Negative for toxigenic C. difficile by the Cepheid nucleic \nacid\n amplification assay.. \n (Reference Range-Negative). \n__________________________________________________________\n___ 9:10 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n__________________________________________________________\n___ 9:10 pm STOOL CONSISTENCY: SOFT\n\n **FINAL REPORT ___\n\n OVA + PARASITES (Final ___: \n CANCELLED. \n Three separate stool specimens collected EVERY OTHER \nDAY are\n recommended for optimum sensitivity. Duplicate \nspecimens collected\n on the same day will not be processed, since this does \nnot\n increase diagnostic yield. Make sure to label date and \ntime of\n collection on each stool specimen submitted to ensure \nappropriate\n processing. \n__________________________________________________________\n___ 9:10 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n__________________________________________________________\nTime Taken Not Noted Log-In Date/Time: ___ 8:17 pm\n BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n__________________________________________________________\n___ 7:07 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH.\n___ yo F with history of ischemic cardiomyopathy (EF ___, \natrial fibrillation (on apixaban), CKD ___ IgA nephropathy s/p 2 \nrenal transplants (most recent ___, non-IDDM, hypothyroidism, \nhypertension and NASH cirrhosis who presented to the ED on\n___ with weakness and confusion found to have PNA and \ncardiogenic shock. \n\nACUTE ISSUES: \n=============\n#Cardiogenic shock\n#Acute on chronic HFrEF\nPatient with history of ischemic cardiomyopathy (EF ___ with \nmultiple recent hospitalizations admitted for acute on chronic \nheart failure exacerbation and cardiogenic shock. Repeat TTE on \n___ showed newly reduced EF 15% to 20% and akinesis of the \ninferior and inferolateral walls which is also new from prior. \nShe was initially treated with dobutamine and levophed, then \ntransitioned to milrinone and digoxin. Palliative care was \nconsulted with decision to pursue discharge to hospice with home \ninotropic therapy. Will not plan for invasive procedures \nincluding cardiac resynchronization therapy at this time. \nPatient will continue palliative milrinone and digoxin at home. \nDigoxin renally dosed at 0.0625mg every other day. Discontinue \nhome diuretics, metoprolol, losartan, and spironolactone in the \nsetting of hypotension.\n\n#Acute on chronic renal failure \n#ATN\nPatient with ___ in setting of shock. S/p transplant ___ IgA \nnephropathy. Baseline Cr around 1.3 which has trended up to 2.0 \non discharge with evidence of muddy brown casts suggestive of \nATN, likely in the setting of cardiogenic shock requiring \npressors and ionotropes as above. Renal U/S otherwise stable \nfrom prior. Will continue home immunosuppression regimen \nincluding: Sirolimus .5 and 1.0 mg every other day, Prednisone 5 \nmg daily, Azathiprine 25 mg daily.\n\n#Transaminitis:\n#Shock liver\n#NASH cirrhosis\nPatient with acute rise in LFTs from normal on admission to \n>1000, likely in the setting of hypoperfusion/shock liver. LFTs \nhave subsequently downtrended with blood pressure support. \nHepatitis serologies negative. \n\n#CAD:\nHolding ASA, statin given limited life expectancy with discharge \nto hospice. Discontinued home metoprolol iso cardiogenic shock. \n\n#Chronic atrial fibrillation:\nHold apixaban given thrombocytopenia and limited life \nexpectancy. Risks likely outweigh benefits at this time.\n\n#PNA\nPatient completed course of vancomycin, cefepime, azithromycin \nfor presumed PNA.\n\n#Hospice Care\nPalliative care was consulted iso end state HFrEF and multiple \nrecent hospitalizatins. ___ and ___ met with palliative care \nduring last her admission in ___. At that time they \nwere facing a rehab admission which was not what ___ wanted. \n___ did have a miraculous recovery and was able to return home \nfor xmas with grandsons. However, after xmas her health has \ncontinued to decline. ___ and ___ are both realistic about \nher progressive chronic illness. Their hope is to live out her \nlife in a meaningful fashion knowing that time may be short. \nThey hope to focus on quality and\nbeing at home. Decision was made to discharge home with hospice. \nWill continue Tylenol and Oxycodone 2.5mg Q6H PRN for pain. \nBenzonatate and Guafenisin for cough.\n\nCHRONIC ISSUES: \n===============\n#Non insulin dependent diabetes\nHolding metformin iso ___, hospice care.\n\n#Hypothyroidism\nContinue 175 mcg levothyroxine daily.\n\nTRANSITIONAL ISSUES: \n====================\n[ ] Discharge home with hospice\n\n#CONTACT/HCP: Name of health care proxy: ___ \nRelationship: Husband \nPhone number: ___ \nCell phone: ___'}}
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{'final_diagnoses': ['Cardiogenic Shock', 'Acute on Chronic Heart Failure', 'Acute tubular necrosis (ATN)'], 'procedures': ['None'], 'visit_summary': '___ yo F with history of ischemic cardiomyopathy (EF ___, \natrial fibrillation (on apixaban), CKD ___ IgA nephropathy s/p 2 \nrenal transplants (most recent ___, non-IDDM, hypothyroidism, \nhypertension and NASH cirrhosis who presented to the ED on\n___ with weakness and confusion found to have PNA and \ncardiogenic shock. \n\nACUTE ISSUES: \n=============\n#Cardiogenic shock\n#Acute on chronic HFrEF\nPatient with history of ischemic cardiomyopathy (EF ___ with \nmultiple recent hospitalizations admitted for acute on chronic \nheart failure exacerbation and cardiogenic shock. Repeat TTE on \n___ showed newly reduced EF 15% to 20% and akinesis of the \ninferior and inferolateral walls which is also new from prior. \nShe was initially treated with dobutamine and levophed, then \ntransitioned to milrinone and digoxin. Palliative care was \nconsulted with decision to pursue discharge to hospice with home \ninotropic therapy. Will not plan for invasive procedures \nincluding cardiac resynchronization therapy at this time. \nPatient will continue palliative milrinone and digoxin at home. \nDigoxin renally dosed at 0.0625mg every other day. Discontinue \nhome diuretics, metoprolol, losartan, and spironolactone in the \nsetting of hypotension.\n\n#Acute on chronic renal failure \n#ATN\nPatient with ___ in setting of shock. S/p transplant ___ IgA \nnephropathy. Baseline Cr around 1.3 which has trended up to 2.0 \non discharge with evidence of muddy brown casts suggestive of \nATN, likely in the setting of cardiogenic shock requiring \npressors and ionotropes as above. Renal U/S otherwise stable \nfrom prior. Will continue home immunosuppression regimen \nincluding: Sirolimus .5 and 1.0 mg every other day, Prednisone 5 \nmg daily, Azathiprine 25 mg daily.\n\n#Transaminitis:\n#Shock liver\n#NASH cirrhosis\nPatient with acute rise in LFTs from normal on admission to \n>1000, likely in the setting of hypoperfusion/shock liver. LFTs \nhave subsequently downtrended with blood pressure support. \nHepatitis serologies negative. \n\n#CAD:\nHolding ASA, statin given limited life expectancy with discharge \nto hospice. Discontinued home metoprolol iso cardiogenic shock. \n\n#Chronic atrial fibrillation:\nHold apixaban given thrombocytopenia and limited life \nexpectancy. Risks likely outweigh benefits at this time.\n\n#PNA\nPatient completed course of vancomycin, cefepime, azithromycin \nfor presumed PNA.\n\n#Hospice Care\nPalliative care was consulted iso end state HFrEF and multiple \nrecent hospitalizatins. ___ and ___ met with palliative care \nduring last her admission in ___. At that time they \nwere facing a rehab admission which was not what ___ wanted. \n___ did have a miraculous recovery and was able to return home \nfor xmas with grandsons. However, after xmas her health has \ncontinued to decline. ___ and ___ are both realistic about \nher progressive chronic illness. Their hope is to live out her \nlife in a meaningful fashion knowing that time may be short. \nThey hope to focus on quality and\nbeing at home. Decision was made to discharge home with hospice. \nWill continue Tylenol and Oxycodone 2.5mg Q6H PRN for pain. \nBenzonatate and Guafenisin for cough.\n\nCHRONIC ISSUES: \n===============\n#Non insulin dependent diabetes\nHolding metformin iso ___, hospice care.\n\n#Hypothyroidism\nContinue 175 mcg levothyroxine daily.\n\nTRANSITIONAL ISSUES: \n====================\n[ ] Discharge home with hospice\n\n#CONTACT/HCP: Name of health care proxy: ___ \nRelationship: Husband \nPhone number: ___ \nCell phone: ___', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q8H', '2. Benzonatate 100 mg PO TID cough', '3. Dextromethorphan-Guaifenesin (Sugar Free) ___ mL PO Q6H:PRN \ncough', '4. Digoxin 0.0625 mg PO EVERY OTHER DAY', '5. Docusate Sodium 100 mg PO BID', '6. Milrinone 0.175 mcg/kg/min IV DRIP INFUSION \nRX *milrinone 1 mg/mL 0.175 mcg/kg/min IV continuous Disp #*50 \nVial Refills:*10', '7. OxyCODONE (Immediate Release) 2.5-5 mg PO Q6H:PRN Pain - \nSevere', '8. Senna 8.6 mg PO BID:PRN Constipation - First Line', '9. AzaTHIOprine 25 mg PO DAILY', '10. Levothyroxine Sodium 175 mcg PO DAILY', '11. PredniSONE 5 mg PO DAILY', '12. Sirolimus 1 mg PO EVERY OTHER DAY', '13. Sirolimus 0.5 mg PO EVERY OTHER DAY \nDaily dose to be administered at 6am']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 71, 'gender': 'F', 'symptoms': 'Transient right hand numbness and weakness', 'medical_history': ['-previous stroke resulting in ischemic right ear deafness', '-HTN', '-hyperlipidemia'], 'family_history': 'no family history of strokes', 'present_illness': "___ year old right handed female who\npresents with a 2 days history of right hand clumsiness which \nresolved and some residual right hand numbness. She had a prior \nstroke last year (after an\nepisode of vertigo) thought to be the result of her combination\nof high blood pressure and cholesterol. She saw a Neurologist\n(Dr. ___ in ___) and was started on aggrenox. In\nearly ___, she stated that she suddenly developed right arm\nweakness and clumsiness that lasted 2 days and then resolved \nwith\nonly a little bit of residual numbness, which has now also\nresolved. She stated that she didn't seek medical attention\nbecause she thought she was developing carpal tunnel as she \nworks\nas a ___. She told the story to her PCP who referred her\nback to see neurology and they ordered another MRI which was \ndone\ntoday. The MRI which was done this evening ___\ndemonstrated several new foci of cortical and white matter and \nT2\nabnormalities in the left anterior circulation. One in the left\ncorpus callosum demonstrates restricted diffusion. An MRA\ndemonstrated critical stenosis and cut offs. Therefore she was\ninstructed to go to the emergency room.\n.\nOn neuro ROS, the pt denies headache, loss of vision, blurred\nvision, diplopia, dysarthria, dysphagia, lightheadedness,\nvertigo, tinnitus. she has right ear hearing difficulty. Denies\ndifficulties producing or comprehending speech. Denies focal\nweakness, numbness, parasthesiae. No bowel or bladder\nincontinence or retention. Denies difficulty with gait, but does\nfeel her balance has been off.\n.\nOn general review of systems, the pt denies recent fever or\nchills. No night sweats or recent weight loss or gain. Denies\ncough, shortness of breath. Denies chest pain or tightness,\npalpitations. Denies nausea, vomiting, diarrhea, constipation \nor\nabdominal pain. No recent change in bowel or bladder habits. \nNo\ndysuria. Denies arthralgias or myalgias. Denies rash.", 'medications': [{'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gemfibrozil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 437.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 8.7, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 203.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72.5', 'valuenum': 72.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical Exam:\nVitals: T:96.9 P:85 R:18 BP:135/64 SaO2:100%\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx\nNeck: Supple, No nuchal rigidity\nPulmonary: Lungs CTA bilaterally without R/R/W\nCardiac: RRR, nl. S1S2, no M/R/G noted\nAbdomen: soft, NT/ND, no masses or organomegaly noted.\nExtremities:warm and well perfused\nSkin: no rashes or lesions noted.\n.\nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive, able to name ___ backward \nwithout\ndifficulty. Language is fluent with intact repetition and\ncomprehension. Normal prosody. There were no paraphasic \nerrors.\nPt. was able to name both high and low frequency objects. Able\nto read without difficulty. Speech was not dysarthric. Able to\nfollow both midline and appendicular commands. Pt. was able to\nregister 3 objects and recall ___ at 5 minutes. The pt. had \ngood\nknowledge of current events. There was no evidence of apraxia \nor\nneglect. Calculation was intact (answers seven quarters in\n$1.75)\n.\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: deaf in right ear\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n.\n-Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally.\nNo adventitious movements, such as tremor, noted. No asterixis\nnoted.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ 5 5 5 5 5 5 5\nR 5 ___ ___ 5 5 5 5 5 5 5\n.\n-Sensory: No deficits to light touch, pinprick, cold sensation,\nvibratory sense, proprioception throughout. No extinction to \nDSS.\n.\n-DTRs:\n Bi Tri ___ Pat Ach\nL 2 2 2 2 1\nR 2 2 2 2 1\nPlantar response was flexor bilaterally.\n.\n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF or HKS bilaterally.\n.\n-Gait: Good initiation. Narrow-based, normal stride and arm\nswing. Able to walk in tandem without difficulty. Romberg\nabsent.\n.\n.\nDischarge examination:\n Subtle right finger extensor weakness and otherwise \nunremarkable save chronic right ear deafness.', 'diagnoses': [{'icd_code': '49121', 'desc': 'Obstructive chronic bronchitis with (acute) exacerbation'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '25002', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5852', 'desc': 'Chronic kidney disease, Stage II (mild)'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': "Admission labs:\n___ 09:58PM BLOOD WBC-8.5 RBC-3.96* Hgb-13.0 Hct-37.1 \nMCV-94 MCH-32.9* MCHC-35.1* RDW-12.5 Plt ___\n___ 09:58PM BLOOD Neuts-63.8 ___ Monos-4.7 Eos-3.1 \nBaso-0.3\n___ 09:58PM BLOOD ___ PTT-29.3 ___\n___ 09:58PM BLOOD Glucose-174* UreaN-21* Creat-0.8 Na-144 \nK-3.7 Cl-108 HCO3-25 AnGap-15\n.\nPertinent labs:\n___ 06:05AM BLOOD PEP-PND IgG-601*\n___ 06:05AM BLOOD RheuFac-<3 CRP-0.4\n___ 06:05AM BLOOD ___ dsDNA-PND\n___ 06:05AM BLOOD ANCA-PND\n___ 06:05AM BLOOD Thrombn-150*\n___ 06:05AM BLOOD ESR-12\n___ 06:05AM BLOOD C3-121 C4-22\n___ 06:05AM BLOOD TSH-1.9\n___ 09:58PM BLOOD CK-MB-3 cTropnT-<0.01\n___ 06:05AM BLOOD CK-MB-3 cTropnT-<0.01\n___ 06:05AM BLOOD ANGIOTENSIN 1 - CONVERTING ___\n___ 06:05AM BLOOD RNP ANTIBODY-PND\n___ 06:05AM BLOOD RO & ___\n___ 06:05AM BLOOD SM ANTIBODY-PND\n.\nStroke risk factors:\n___ 06:05AM BLOOD TotProt-5.5* Albumin-4.2 Globuln-1.3* \nCalcium-8.8 Phos-4.2 Mg-2.2 Cholest-126\n___ 06:05AM BLOOD Triglyc-70 HDL-42 CHOL/HD-3.0 LDLcalc-70\n___ 06:05AM BLOOD %HbA1c-5.7 eAG-117\n.\nDischarge labs:\n___ 06:05AM BLOOD WBC-7.8 RBC-3.91* Hgb-12.5 Hct-36.9 \nMCV-94 MCH-32.1* MCHC-34.0 RDW-12.4 Plt ___\n___ 06:05AM BLOOD ___ PTT-48.0* ___\n___ 06:05AM BLOOD Glucose-113* UreaN-19 Creat-0.6 Na-143 \nK-3.7 Cl-110* HCO3-25 AnGap-12\n___ 06:05AM BLOOD TotProt-5.5* Albumin-4.2 Globuln-1.3* \nCalcium-8.8 Phos-4.2 Mg-2.2 Cholest-126\n___ 06:05AM BLOOD ALT-25 AST-19 LD(LDH)-159 CK(CPK)-93 \nAlkPhos-52 TotBili-0.4\n.\n.\nUrine:\n___ 01:37AM URINE Color-Straw Appear-Hazy Sp ___\n___ 01:37AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-MOD\n___ 01:37AM URINE RBC-1 WBC-10* Bacteri-FEW Yeast-NONE \nEpi-3\n___ 07:00AM URINE Mucous-OCC\n___ 07:00AM URINE Hours-RANDOM TotProt-16\n___ 07:00AM URINE U-PEP-PND\n___ 07:00AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n___ 07:00AM URINE Color-Yellow Appear-Clear Sp ___\n___ 07:00AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-SM \n___ 07:00AM URINE RBC-3* WBC-8* Bacteri-MOD Yeast-NONE \nEpi-4\n.\n.\nMicrobiology:\n___ PLASMA REAGIN \nTEST-PENDING\n___ SEROLOGY-PENDING\n___ 06:05AM BLOOD HCV Ab-NEGATIVE\n___ 06:05AM BLOOD HEPATITIS Be ANTIBODY-PND\n___ 06:05AM BLOOD HEPATITIS Be ANTIGEN-PND\n___ year old right handed female with a past history of previous \nstrokes and resultant right ear deafness, HTN, HLD presents \nafter MRI shows new abnormalities. The patient was admitted and \ndischarged from the stroke service ___. \n\nThe patient had who a transient episode of 2 days of right hand \nclumsiness and numbness at the beginning of ___. This was \ninitially attributed to carpal tunnel syndrome however when \nEMG/NCS were unrevealing she went on to have an MRI which showed \nby report (the MRI was done at an outside institution and we \nwere unable to review the images) new foci of cortical and white \nmatter DWI and T2 hyperintensity in the left anterior \ncirculation, one of which in the left corpus callosum \ndemonstrates restricted diffusion, most suggestive of subacute / \nacute infarct in addition to a new focus of linear \nsusceptibility in the left pareital cortical vessel of \nconceivably could represent thromboembolism. She also had an MRA \nwhich showed apparently new severe narrowing or cutoff of a \nposterior trunk of left MCA at anterior sylvian fissure with \nattenuation of multiple posterior and insular branches. The \npatient's examination was at baseline on assessment at ___ \nsave chronic right ear deafness and subtle right finger \nextension weakness. Outside records were sought. Out of concern \nfor cardioembolism as suggested by the MRI report, the patient \nwas placed on a heparin IV infusion. \n\nThe patient had a number of labs sent many of which are pending \nat the time of writing to evaluate for vasculitis/vasculopathy \nand related causes.\n\nSummary of available results reveals ESR 12, CRP 0.2, normal \nLFTs, negative CEs, low total protein 5.5 with low IgG 601, \nnormal C3/4, negative RF, TSH 1.9, Hep C Ab negative.\n\nStroke risk factors were addressed and urine/serum toxicologies \nwere negative, HbA1c 5.7%, Chol 126, LDL 70. Patient was \nmonitored on telemetry and there were no arrhythmias captured. \nUA showed evidence of UTI and the patient was started on a 3 day \ncourse of Bactrim.\n\nPatient was evaluated with a CXR which was unremarkable. CTA \nhead and neck revealed no evidence of hemorrhage or acute \ninfarction with multiple chronic lacunes and no evidence of \nvascular stenosis or occlusion with atheromatous calcifications \nat the origin of the right ICA but no evidence of stenoses and a \nsmall right anterior cerebral artery appeared by our \nradiologists to be a normal variant.\n\nGiven that the patient had further strokes which are currently \ncryptogenic in aetiology, aggrenox was stopped and clopidogrel \nwas started in its place. Given adequate LDL levels, the patient \nwas continued on atorvastatin 80mg qd. BP was controlled in \nhouse and patient was continued on lisinopril 10mg qd. \n\nPatient was advised to make ___ arrangements with Dr \n___ neurologist for 4 weeks and PCP ___ within 1 \nweek. The patient was advised to acquire a CD of her MRI/MRA \nimages to take with her to her neurology appointment. An \noutpatient echo with bubble was requested and should happen \nbefore her clinic appointment. Patient was advised to re-present \nif she has further symptoms."}}
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{'final_diagnoses': ['New strokes currently cryptogenic regarding aetiology', 'Urinary tract infection'], 'procedures': ['None'], 'visit_summary': "___ year old right handed female with a past history of previous \nstrokes and resultant right ear deafness, HTN, HLD presents \nafter MRI shows new abnormalities. The patient was admitted and \ndischarged from the stroke service ___. \n\nThe patient had who a transient episode of 2 days of right hand \nclumsiness and numbness at the beginning of ___. This was \ninitially attributed to carpal tunnel syndrome however when \nEMG/NCS were unrevealing she went on to have an MRI which showed \nby report (the MRI was done at an outside institution and we \nwere unable to review the images) new foci of cortical and white \nmatter DWI and T2 hyperintensity in the left anterior \ncirculation, one of which in the left corpus callosum \ndemonstrates restricted diffusion, most suggestive of subacute / \nacute infarct in addition to a new focus of linear \nsusceptibility in the left pareital cortical vessel of \nconceivably could represent thromboembolism. She also had an MRA \nwhich showed apparently new severe narrowing or cutoff of a \nposterior trunk of left MCA at anterior sylvian fissure with \nattenuation of multiple posterior and insular branches. The \npatient's examination was at baseline on assessment at ___ \nsave chronic right ear deafness and subtle right finger \nextension weakness. Outside records were sought. Out of concern \nfor cardioembolism as suggested by the MRI report, the patient \nwas placed on a heparin IV infusion. \n\nThe patient had a number of labs sent many of which are pending \nat the time of writing to evaluate for vasculitis/vasculopathy \nand related causes.\n\nSummary of available results reveals ESR 12, CRP 0.2, normal \nLFTs, negative CEs, low total protein 5.5 with low IgG 601, \nnormal C3/4, negative RF, TSH 1.9, Hep C Ab negative.\n\nStroke risk factors were addressed and urine/serum toxicologies \nwere negative, HbA1c 5.7%, Chol 126, LDL 70. Patient was \nmonitored on telemetry and there were no arrhythmias captured. \nUA showed evidence of UTI and the patient was started on a 3 day \ncourse of Bactrim.\n\nPatient was evaluated with a CXR which was unremarkable. CTA \nhead and neck revealed no evidence of hemorrhage or acute \ninfarction with multiple chronic lacunes and no evidence of \nvascular stenosis or occlusion with atheromatous calcifications \nat the origin of the right ICA but no evidence of stenoses and a \nsmall right anterior cerebral artery appeared by our \nradiologists to be a normal variant.\n\nGiven that the patient had further strokes which are currently \ncryptogenic in aetiology, aggrenox was stopped and clopidogrel \nwas started in its place. Given adequate LDL levels, the patient \nwas continued on atorvastatin 80mg qd. BP was controlled in \nhouse and patient was continued on lisinopril 10mg qd. \n\nPatient was advised to make ___ arrangements with Dr \n___ neurologist for 4 weeks and PCP ___ within 1 \nweek. The patient was advised to acquire a CD of her MRI/MRA \nimages to take with her to her neurology appointment. An \noutpatient echo with bubble was requested and should happen \nbefore her clinic appointment. Patient was advised to re-present \nif she has further symptoms.", 'medications_prescribed': ['1. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', '3. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) \nTablet PO BID (2 times a day) for 3 days.\nDisp:*6 Tablet(s)* Refills:*0*', '4. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '5. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'M', 'symptoms': 'Asymptomatic 90% left-sided carotid stenosis', 'medical_history': ['-Coronary Artery Disease', '-Chronic Elevation Right Hemidiaphagm(secondary to MVA)', '-Chronic Obstructive Pulmonary Disease', '-Glucose Intolerance', '-Hypertension', '-Hypogonadism', '-Sleep Apnea, uses CPAP at night', '-Varicose Veins, Venous Insufficiency(wears compression\nstockings)'], 'family_history': 'no family history of premature coronary artery disease, \nunexplained heart failure, or sudden death', 'present_illness': 'This is a ___ gentleman found to have\nasymptomatic 90% left-sided carotid stenosis. Patient was\ncounseled on relative benefit in terms of stroke risk of\nhaving this repaired and presented today for elective carotid\nendarterectomy.', 'medications': [{'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 557.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.89', 'valuenum': 4.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vital signs stable\nGen: AAO, no acute distress\nHEENT: Sclera anicteric, MMM, left neck wound clean, dry and \nintact with steri-strips in place. No erythema, swelling, \ndischarge or signs of infection. No carotid bruit on the right \nside.\nLungs: clear to auscultation bilaterally, no distress\nCV: regular rate and rhythm, no murmur or gallops\nAbd: Soft, non tender, non distended\nExt: Palpable radial pulses bilaterally. Palpable femoral, \npopliteal, DP and ___ bilaterally.', 'diagnoses': [{'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': 'V1272', 'desc': 'Personal history of colonic polyps'}], 'summary': "___ 04:22AM BLOOD Hct-34.4*\n___ 04:22AM BLOOD Creat-1.1 K-3.8\nMr. ___ is a ___ years old man with left carotid stenosis \nwho was admitted to the ___ on \n___. The patient was taken to the OR and underwent left \ncarotid endarterectomy. For details of the procedure, please see \n\nthe surgeon's operative note. The patient tolerated the \nprocedure well without complications and was brought to the \npost-anesthesia care unit in stable condition. After a brief \nstay, the patient was transferred to the vascular surgery floor \nwhere he remained through the rest of the hospitalization. \n\nPost-operatively, he did well without any neck swelling, and an \nintact neurological exam. He was able to tolerate a regular \ndiet, get out of bed and ambulate \nwithout assistance, void without issues, and pain was controlled \non oral medications alone. He was deemed ready for discharge, \nand was given the appropriate discharge and follow-up \ninstructions."}}
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{'final_diagnoses': ['Asymptomatic 90% left carotid stenosis.'], 'procedures': ['Left carotid endarterectomy'], 'visit_summary': "Mr. ___ is a ___ years old man with left carotid stenosis \nwho was admitted to the ___ on \n___. The patient was taken to the OR and underwent left \ncarotid endarterectomy. For details of the procedure, please see \n\nthe surgeon's operative note. The patient tolerated the \nprocedure well without complications and was brought to the \npost-anesthesia care unit in stable condition. After a brief \nstay, the patient was transferred to the vascular surgery floor \nwhere he remained through the rest of the hospitalization. \n\nPost-operatively, he did well without any neck swelling, and an \nintact neurological exam. He was able to tolerate a regular \ndiet, get out of bed and ambulate \nwithout assistance, void without issues, and pain was controlled \non oral medications alone. He was deemed ready for discharge, \nand was given the appropriate discharge and follow-up \ninstructions.", 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H', '2. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours \nDisp #*20 Tablet Refills:*0', '3. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB, wheeze', '4. Aspirin 81 mg PO DAILY', '5. Carvedilol 20 mg PO DAILY', '6. Hydrochlorothiazide 25 mg PO DAILY', '7. Losartan Potassium 100 mg PO DAILY', '8. Rosuvastatin Calcium 40 mg PO QPM']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 38, 'gender': 'M', 'symptoms': 'Low grade fevers, nausea, and RUQ pain', 'medical_history': ['-Primary sclerosing cholangitis (PSC)', '-___ Laparoscopic cholecystectomy with liver\nbiopsy.', '-Celiac sprue: diagnosed by bx, slightly elevated tTG', '-HTN', '-GERD', '-Hypothyroidim', '-OSA previously on CPAP - negative on repeat testing ', "-?IBD (Crohn's dx'd at ___ at the age of ___, but questionable dx\nas no sx for over ___ years)"], 'family_history': 'NO liver disease or liver cancer. \nF: late onset DM2, CAD\nM: thyroid disease\n2 sisters, 1 brother - thyroid condition', 'present_illness': 'Ms. ___ is a ___ yo F with history of PSC (not yet on the \ntransplant list) s/p CCY in ___ who presents with right \nupper quadrant abdomen pain, nausea, and weight loss. She \nreports that she has been feeling nausea for at least 2 weeks \nand tried changing her doxycycline for prophylaxis to cipro but \nthere has not been any improvement. She has not vomited nor had \ndiarrhea or constipation. The abd pain is in the RUQ and feels \nlike a sharp pain that comes in waves when she eats. It is not \nspecific to fatty food, but hurts about 15 min after eating any \ntime of food. This morning, she did have a fever to about 100.0 \nand called Dr. ___ advised her to come into the \nhosptial.\n \nLabs on ___ significant for normal CBC, normal chemistry \npanel, AST 34, ALT 44, alk phos 154 (recently 103 a month ago), \ntbili 1.7 (baseline 1.0).', 'medications': [{'medication': 'Duloxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Creon 12', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.75', 'valuenum': 4.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.87', 'valuenum': 4.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission:\nVS: 98.1, 130/74, 68, 18, 100% RA\nGENERAL: Well appearing in NAD. not jaundiced\nHEENT: Sclera anicteric. MMM. \nCARDIAC: RRR nl S1 S2, no m/r/g \nLUNGS: CTA b/l with no wheezing, rales, or rhonchi.\nABDOMEN: Soft, tender to palpation in the RUQ, worse with deep \ninspiration but able to take full breath. no Dullness to \npercussion. No HSM or tenderness appreciated. \nEXTREMITIES: no edema b/l. Warm and well perfused, no clubbing \nor cyanosis. \nNEUROLOGY: no asterixis, normal gait, ___ strength in all \nextremities \n\nDischarge:\nVS: 97.6, 131/73, 65, 18, 100% RA\nGENERAL: Well appearing in NAD. not jaundiced\nHEENT: Sclera anicteric. MMM. \nCARDIAC: RRR nl S1 S2, no m/r/g \nLUNGS: CTA b/l with no wheezing, rales, or rhonchi.\nABDOMEN: Soft, tender to palpation in the RUQ, worse with deep \ninspiration but able to take full breath. no Dullness to \npercussion. No HSM or tenderness appreciated. \nEXTREMITIES: no edema b/l. Warm and well perfused, no clubbing \nor cyanosis. \nNEUROLOGY: no asterixis, normal gait, ___ strength in all \nextremities ', 'diagnoses': [{'icd_code': '78900', 'desc': 'Abdominal pain, unspecified site'}, {'icd_code': '5770', 'desc': 'Acute pancreatitis'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': 'Admission:\n\n___ 08:50PM BLOOD WBC-6.8# RBC-4.25 Hgb-13.6 Hct-40.7 \nMCV-96 MCH-32.1* MCHC-33.5 RDW-13.3 Plt ___\n___ 08:50PM BLOOD Glucose-89 UreaN-13 Creat-0.6 Na-141 \nK-3.9 Cl-102 HCO3-30 AnGap-13\n___ 08:50PM BLOOD ALT-35 AST-27 LD(LDH)-157 AlkPhos-149* \nTotBili-0.9\n___ 08:50PM BLOOD Calcium-9.6 Phos-4.1 Mg-2.2\n\nDischarge:\n___ 07:10AM BLOOD WBC-4.9 RBC-4.34 Hgb-13.9 Hct-41.6 MCV-96 \nMCH-32.0 MCHC-33.3 RDW-13.4 Plt ___\n___ 07:10AM BLOOD Glucose-91 UreaN-11 Creat-0.7 Na-140 \nK-4.0 Cl-103 HCO3-28 AnGap-13\n___ 07:10AM BLOOD ALT-36 AST-28 LD(LDH)-182 AlkPhos-145* \nTotBili-1.4\n___ 07:10AM BLOOD Calcium-9.5 Phos-4.0 Mg-2.2\nMs. ___ is a ___ yo F with history of PSC (not yet on \ntransplant list) status post cholecystectomy in ___ who \npresents with RUQ prandial abdominal pain, nausea, and anorexia \ndue to pain.\n\n# RUQ pain: Her history of post-prandial pain and crampy quality \nalong with the slight elevations in alk phos and Tbili are \nconsistent with a flare in cholangitis. She remained afebrile \nwithout leukocytosis this admission. A CT abdomen was reassuring \nwith no acute inflammation or stricture appreciated. An interval \nincrease in common bile duct was noted from 7mm->10mm from \nprevious MRCP but this can occur following cholecystectomy. She \nwill continue cirpofloxacin 500mg BID for 2 weeks until follow \nup with Dr. ___. She will also have an outpatient MRCP and \nHIDA scan this week to further evaluate biliary tract for \nstricture. \n\n# PSC with cirrhosis: Biopsy from ___ showed stage ___ \nfibrosis. As above, likely undergoing a flare. Not yet on \ntransplant list nor up to date with her cirrhosis screening EGD. \n She is not currently experiencing any cirrhotic decompensations \nand no history of HE, ascites, or varices. She was continued on \nursodiol 300mg BID. On discharge as an outpatient: should have q \n6 month liver ultrasound with AFP (US UTD but not AFP) and \ndiscuss interval for screening EGD (last ___ was completely \nnormal)\n\n# HTN: normotensive this admission on home lisinopril and \nfurosemide\n\n# Hypothyroidism: continued home levothyroxine\n\n# GERD: continued home omeprazole'}}
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{'final_diagnoses': ['Primary sclerosing cholangitis', 'Diabetes Mellitus, Type II'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ yo F with history of PSC (not yet on \ntransplant list) status post cholecystectomy in ___ who \npresents with RUQ prandial abdominal pain, nausea, and anorexia \ndue to pain.\n\n# RUQ pain: Her history of post-prandial pain and crampy quality \nalong with the slight elevations in alk phos and Tbili are \nconsistent with a flare in cholangitis. She remained afebrile \nwithout leukocytosis this admission. A CT abdomen was reassuring \nwith no acute inflammation or stricture appreciated. An interval \nincrease in common bile duct was noted from 7mm->10mm from \nprevious MRCP but this can occur following cholecystectomy. She \nwill continue cirpofloxacin 500mg BID for 2 weeks until follow \nup with Dr. ___. She will also have an outpatient MRCP and \nHIDA scan this week to further evaluate biliary tract for \nstricture. \n\n# PSC with cirrhosis: Biopsy from ___ showed stage ___ \nfibrosis. As above, likely undergoing a flare. Not yet on \ntransplant list nor up to date with her cirrhosis screening EGD. \n She is not currently experiencing any cirrhotic decompensations \nand no history of HE, ascites, or varices. She was continued on \nursodiol 300mg BID. On discharge as an outpatient: should have q \n6 month liver ultrasound with AFP (US UTD but not AFP) and \ndiscuss interval for screening EGD (last ___ was completely \nnormal)\n\n# HTN: normotensive this admission on home lisinopril and \nfurosemide\n\n# Hypothyroidism: continued home levothyroxine\n\n# GERD: continued home omeprazole', 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN pain \nUp to 6 tablets daily ', '2. Ciprofloxacin HCl 500 mg PO Q12H \nAlternate every two weeks with Doxycyline. Take until ___. ', '3. Docusate Sodium 100 mg PO BID ', '4. Escitalopram Oxalate 20 mg PO DAILY ', '5. Furosemide 20 mg PO DAILY ', '6. Levothyroxine Sodium 75 mcg PO DAILY ', '7. Lisinopril 5 mg PO DAILY ', '8. Omeprazole 20 mg PO DAILY ', '9. Senna 1 TAB PO BID:PRN constipation ', '10. Ursodiol 300 mg PO BID ', '11. Doxycycline Hyclate 100 mg PO Q12H \nAlternate every two weeks with Cipro ', '12. Ondansetron 4 mg PO Q8H:PRN nausea \nRX *ondansetron 4 mg 1 tablet(s) by mouth q8hrs prn Disp #*10 \nTablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 79, 'gender': 'M', 'symptoms': 'Hypoxia.', 'medical_history': ["- B-cell non-Hodgkin's lymphoma, diagnosed after right renal \nmass found in ___, no evidence of recurrence based on ___ CT, \non maintenance Rituxan", '- Hypertension', '- Osteoarthritis', '- Left pre-patellar bursitis', '- Spinal stenosis, followed at ___ pain ___ with epidural \nsteroid injections', '- Hyperlipidemia', '- Status-post cataract surgery', '- Squamous cell carcinoma of the lower extremities, status-post \nbilateral Mohs procedure ___', '- Chest pain, evaluated by Dr. ___ in ___, \nfelt to be related to depression over loss of husband.\n___ palpitations. Pre-operative testing in ___ all \nwithin normal limits.', '- Depression', '- Anemia'], 'family_history': 'There is no family history of premature coronary artery disease \nor sudden death; her mother and father did have cardiac disease. \nOne daughter passed away at age ___ of GI malignancy.', 'present_illness': '(History obtained via chart review, over phone via ___ \nInterpreter, and via phone call with daughter). \nMs. ___ is a ___ year old woman with history of lymphoma and \nhypertension who presented to the ___ emergency room after an \noffice visit with cardiology for shortness of breath. She \nreported that she had increasing dyspnea on exertion for a \nmonth, as well as some associated lower extremity edema and \nweight gain of an undetermined amount. She had not had any PND \nor orthopnea, chest discomfort, or palpitations. She had a dry \ncough and occasional wheezing, but no fevers or flu-like \nsymptoms. She had felt markedly dyspneic with exertion from her \nbed to her bathroom necessitating several stops. She reported \ntaking her medications as directed. Her PCP last week started \nher on a nitroglycerin patch without any change in her symptoms. \nPer report, her exam at that time was unremarkable. She was \nreferred to cardiology for further evaluation. Her daughter adds \nadditional history that patient has been very fatigued and \n"slowed down" a lot over the last month, with less strength; \npreviously she was very active, but currently she does not climb \nup any stairs. She confirmed the patient has had a dry cough \nrecently. \n \nShe was seen in cardiology clinic on the day of admission for \nthese complaints, at which time her vitals signs were notable \nfor a blood pressure of 190/75, heart rate of 100, and oxygen \nsaturation of 95-95% on room air decreasing to the mid-80\'s on \nexertion. Her JVP was felt to be about ___, and an EKG \ndemonstrated sinus rhythm at a rate of 100, with left anterior \nfasicular block and poor R wave progression. She was referred to \nthe ED for further evaluation and admission for her hypoxia and \nshortness of breath. \n \nIn the ED, her vitals were temperature of 99.5, BP 170/80, HR \n96, and RR 25, with oxygen saturation of 100% on 4L, 92% laying \ndown on room air. Her EKG was not concerning for ischemia. She \nwas given 325 mg of aspirin. Given her hypoxia, mild \ntachycardia, and malignancy history, she underwent a CTA to rule \nout pulmonary embolism, which was negative. She was guaiac \nnegative. She was transferred to the floor for further \nevaluation \n\nUpon arrival to the floor, she reported her breathing was no \ndifferent, and she did not feel overly dyspneic. She denied \nchest pain, dizziness, headache, nausea, or any other current \ncomplaints.', 'medications': [{'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '65', 'valuenum': 65.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '358', 'valuenum': 358.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '423', 'valuenum': 423.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 121.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SOME WITH PROMINENT NUCLEOLI.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW HYPERSEGMENTED.'}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'VERY LOW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCCASIONAL.'}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.38', 'valuenum': 2.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.1, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 121.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '417', 'valuenum': 417.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '372', 'valuenum': 372.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '21.6', 'valuenum': 21.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.61', 'valuenum': 2.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '501', 'valuenum': 501.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.87', 'valuenum': 2.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 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'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '343', 'valuenum': 343.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERY LOW.'}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '84', 'valuenum': 84.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERY LOW.'}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERY LOW.'}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 65 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'AVAILABLE AT THE ___ LAB.'}, {'value': '76', 'valuenum': 76.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': "VITALS - T 97.4, BP 131/56, HR 82, RR 20, 95% on room air. \nTm 98.0, 122-131/56-80, 70-82, 20, 95-97% RA, \n\nAt the time of discharge, the patient had O2 saturation in the \nhigh 90's on room air, and 91% while ambulatory. Her dry weight \nafter diuresis was 56kg. Her dry weight BNP was 387.\n\nGen: NAD. Mood, affect appropriate. Able to converse in limited \n___. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNeck: Supple with JVD to mid-neck. No LAD appreciated. \nCV: regular, normal S1, S2. soft systolic murmur at apex. No \nrubs or gallops. No thrills, lifts. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. \nAbd: Soft, non-tender, non-distended. \nExt: no clubbing, cyanosis, or edema. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas. \n\nPulses: \nRight: Radial 2+ DP 2+ ___ 2+ \nLeft: Radia 2+ DP 2+ ___ 2+", 'diagnoses': [{'icd_code': '2536', 'desc': 'Other disorders of neurohypophysis'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '28800', 'desc': 'Neutropenia, unspecified'}, {'icd_code': '23875', 'desc': 'Myelodysplastic syndrome, unspecified'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '71941', 'desc': 'Pain in joint, shoulder region'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '78052', 'desc': 'Insomnia, unspecified'}, {'icd_code': '71947', 'desc': 'Pain in joint, ankle and foot'}], 'summary': 'Labs on admission:\n___ 06:00PM BLOOD WBC-6.3 RBC-3.01* Hgb-10.3* Hct-28.4* \nMCV-94 MCH-34.2* MCHC-36.2* RDW-13.4 Plt ___\n___ 06:00PM BLOOD Neuts-72* Bands-1 Lymphs-14* Monos-11 \nEos-0 Baso-0 Atyps-2* ___ Myelos-0\n___ 06:00PM BLOOD ___ PTT-25.0 ___\n___ 06:00PM BLOOD Glucose-81 UreaN-21* Creat-0.8 Na-135 \nK-3.9 Cl-103 HCO3-21* AnGap-15\n___ 06:00PM BLOOD ALT-16 AST-22 CK(CPK)-127 AlkPhos-67 \nTotBili-0.4\n___ 06:00PM BLOOD Lipase-37\n___ 06:00PM BLOOD CK-MB-8 proBNP-700*\n___ 06:00PM BLOOD Iron-30\n___ 06:00PM BLOOD calTIBC-222* VitB12-721 Folate-11.3 \nFerritn-216* TRF-171*\n___ 06:00PM BLOOD TSH-1.8\n\nLabs on discharge:\n___ 07:10AM BLOOD WBC-7.8 RBC-3.28* Hgb-11.0* Hct-29.8* \nMCV-91 MCH-33.5* MCHC-36.8* RDW-14.3 Plt ___\n___ 07:10AM BLOOD Glucose-151* UreaN-36* Creat-1.3* Na-133 \nK-3.6 Cl-94* HCO3-24 AnGap-19\n___ 07:10AM BLOOD Mg-2.0\n___ 07:10AM BLOOD proBNP-387\n\nChest x-ray ___:\nLung volumes are diminished with bibasilar predominantly linear \nopacities most suggestive of atelectasis. No definite focal \nconsolidation or superimposed edema is identified. The aorta is \nmildly tortuous. The cardiac silhouette is enlarged but stable. \nNo definite effusion or pneumothorax is seen. Bridging \nosteophytes are noted throughout the thoracic spine. There is a \nslightly exaggerated kyphosis in the mid thoracic spine. \nDeformity of the right humeral head is again noted consistent \nwith remote healed trauma. \n\nChest CT (CTA) ___: \n1. No evidence of pulmonary embolism. \n2. Patchy scattered ground-glass opacity likely related to \natelectasis. \n\nECHO ___:\nThe left atrium and right atrium are normal in cavity size. The \ninteratrial septum is aneurysmal. No atrial septal defect is \nseen by 2D or color Doppler. There is mild symmetric left \nventricular hypertrophy with normal cavity size and global \nsystolic function (LVEF>55%). Due to suboptimal technical \nquality, a focal wall motion abnormality cannot be fully \nexcluded. Right ventricular chamber size and free wall motion \nare normal. The aortic valve leaflets appear structurally normal \nwith good leaflet excursion. No aortic regurgitation is seen. \nThe mitral valve leaflets are mildly thickened. Trivial mitral \nregurgitation is seen. The pulmonary artery systolic pressure \ncould not be estimated. There is no pericardial effusion. \n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with \npreserved global biventricular systolic function.\n\nCompared with the report of the prior study (images unavailable \nfor review) of ___, no aortic regurgitation or significant \nmitral regurgitation is seen on the current study.\nPatient is a very pleasant ___ year old ___ speaking female \nwith past medical history of lymphoma and hypertension who \npresents with new hypoxia. \n \n#. Hypoxia/Dyspnea: Given her weight gain, elevated JVP, \nscattered rales, and improvement with sitting upward, it was \nfelt the most likely etiology was new congestive heart failure. \nPulmonary embolism (given history of malignancy, tachycarida and \nhypoxia) was ruled out with a negative CTA. She had no fevers, \nsputum production, or other features to suggest infectious \nprocess. Chest x-ray did show some atelectasis. Her story was \nless consistent with ischemia, but she was ruled out for MI. \nThere were no features to suggest influenza. In setting of \nmarked hypertension, diastolic dysfunction is the most likely \ncause of her shortness of breath. She was given incentive \nspirometry, Atrovent/xoponex inhalers, and diuresed with IV \nLasix. Her meclizine was held. ECHO showed normal systolic \nfunction. The patient shortness of breath improved with \ndiuresis. At the time of discharge, the patient had O2 \nsaturation in the high 90\'s on room air, and 91% while \nambulatory. Her dry weight after diuresis was 56kg.\n\nThe patient was continued on Aspirin, her beta-blocker was \nchanged to Metoprolol from Atenolol, and continued on her \nstatin.\n\n#. Arthritis pain: The patient was continued her Lidoderm patch \nand Tylenol for her knee pain. Her Neurontin was held given her \ndaughter reporting that she has not been taking it lately.\n\n#. Altered Mental Status/Delerium: During the admission, the \npatient went through "sundowning" which initially involved \nvisual hallucinations of people outside her window which \nresolved. She spoke at length of what appeared to be her past in \n___ with some confusion. She did remain oriented, when \nprompted, to person, place and time. Her daughter stated that \nshe could easily become confused with medications, and all \npsychoactive medications were held.'}}
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{'final_diagnoses': ['Diastolic Heart Failure.'], 'procedures': ['None.'], 'visit_summary': 'Patient is a very pleasant ___ year old ___ speaking female \nwith past medical history of lymphoma and hypertension who \npresents with new hypoxia. \n \n#. Hypoxia/Dyspnea: Given her weight gain, elevated JVP, \nscattered rales, and improvement with sitting upward, it was \nfelt the most likely etiology was new congestive heart failure. \nPulmonary embolism (given history of malignancy, tachycarida and \nhypoxia) was ruled out with a negative CTA. She had no fevers, \nsputum production, or other features to suggest infectious \nprocess. Chest x-ray did show some atelectasis. Her story was \nless consistent with ischemia, but she was ruled out for MI. \nThere were no features to suggest influenza. In setting of \nmarked hypertension, diastolic dysfunction is the most likely \ncause of her shortness of breath. She was given incentive \nspirometry, Atrovent/xoponex inhalers, and diuresed with IV \nLasix. Her meclizine was held. ECHO showed normal systolic \nfunction. The patient shortness of breath improved with \ndiuresis. At the time of discharge, the patient had O2 \nsaturation in the high 90\'s on room air, and 91% while \nambulatory. Her dry weight after diuresis was 56kg.\n\nThe patient was continued on Aspirin, her beta-blocker was \nchanged to Metoprolol from Atenolol, and continued on her \nstatin.\n\n#. Arthritis pain: The patient was continued her Lidoderm patch \nand Tylenol for her knee pain. Her Neurontin was held given her \ndaughter reporting that she has not been taking it lately.\n\n#. Altered Mental Status/Delerium: During the admission, the \npatient went through "sundowning" which initially involved \nvisual hallucinations of people outside her window which \nresolved. She spoke at length of what appeared to be her past in \n___ with some confusion. She did remain oriented, when \nprompted, to person, place and time. Her daughter stated that \nshe could easily become confused with medications, and all \npsychoactive medications were held.', 'medications_prescribed': ['Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO once a day.', 'Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed.', 'Senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day) \nas needed.', 'Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO DAILY (Daily).', 'Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO QHS (once \na day (at bedtime)).', 'Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical DAILY (Daily).', 'Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', 'Furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 32, 'gender': 'M', 'symptoms': 'Palpitations/Jaw Tightness', 'medical_history': ['1. CARDIAC RISK FACTORS: (-) Diabetes, (+) Dyslipidemia, (+) \nHypertension', '2. CARDIAC HISTORY: \n-CABG: none\n-PERCUTANEOUS CORONARY INTERVENTIONS: LHC in ___, DES to RCA, \nsee below', '-PACING/ICD: none', '3. OTHER PAST MEDICAL HISTORY: \nHTN\nGERD'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death; otherwise non-contributory. Paternal \ngrandfather died of MI in ___ decade of life', 'present_illness': 'Ms. ___ is a ___ F with h/o CAD s/p DES to RCA, presenting \nwith palpitations and jaw discomfort. Cath in ___ done b/c of \npalpiations. Today she was walking around and had sudden onset \nof palpitation with associated jaw tightness. Denies chest pain \nbut felt "funny" in that area of her jaw. Lasted ___ minutes; \nable to walk around and did fine. Then walked up stairs, felt \npalpitations, warm, clammy/mild diaphoresis and came in to ED. \nNo dyspnea, PND, orthopnea, nausea, or vomiting. Palpitations \nlasted for 30 seconds, and jaw discomfort lasted for ___ \nminutes. Both spontaneously resolved at rest. No other \nassociated symptoms. Patient denies similar pain at rest or \nwith exertion over past few weeks.\n.\n.\nIn the ED, vitals were: 97 64 165/88 14 100%2L. Well \nappearing, unremarkable exam. ECG showed NSR 62, no STEMI, TWI \nin V2 (old). CXR was unremarkable, see below. First set of \nenzymes were negative. She received aspirin 325 mg once, and \nwas transferred upstairs.\n.\nOn evaluation on the floor, pt was asymptomatic, denied jaw \npain/palpitations, and felt well.\n.\n.\nREVIEW OF SYSTEMS: \nShe denies any prior history of stroke, TIA, deep venous \nthrombosis, pulmonary embolism, bleeding at the time of surgery, \nmyalgias, joint pains, cough, hemoptysis, black stools or red \nstools. She denies recent fevers, chills or rigors. She denies \nexertional buttock or calf pain. All of the other review of \nsystems were negative. \n.\nCardiac review of systems is notable for absence of chest pain, \ndyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, \nankle edema, palpitations, syncope or presyncope.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.0', 'valuenum': 42.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.96', 'valuenum': 4.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.44', 'valuenum': 5.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: T= 97 BP= 162/84 HR= 56 RR= 18 O2 sat= 100% 2 L n/c \nGENERAL: WDWN caucasian female in NAD. Oriented x3. Mood, affect \nappropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple with JVP of 3 cm. \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or \nS4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not \nenlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': '6820', 'desc': 'Cellulitis and abscess of face'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '04111', 'desc': 'Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}, {'icd_code': '7821', 'desc': 'Rash and other nonspecific skin eruption'}], 'summary': '___ 02:40PM ___ PTT-22.5 ___\n___ 02:40PM PLT COUNT-306\n___ 02:40PM WBC-8.1 RBC-4.17* HGB-13.1 HCT-37.1 MCV-89 \nMCH-31.4 MCHC-35.3* RDW-13.0\n___ 02:40PM cTropnT-<0.01\n___ 02:40PM estGFR-Using this\n___ 02:40PM GLUCOSE-113* UREA N-23* CREAT-0.7 SODIUM-139 \nPOTASSIUM-4.5 CHLORIDE-104 TOTAL CO2-23 ANION GAP-17\n___ 11:00PM TSH-2.5\n___ 11:00PM CK-MB-NotDone cTropnT-<0.01\n___ 11:00PM CK(CPK)-37\n\nWBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct \n5.7 4.22 12.9 37.4 89 30.5 34.4 12.6 273\n\nUreaN Creat Na K Cl HCO3 AnGap \n 15 0.6 141 4.2 105 27 13\n\ntrop <0.01 x 3\n\nCholest Triglyc HDL CHOL/HD LDLcalc \n 219 220 50 4.4 125 \n\nSUMMARY OF DATA FROM THE EXERCISE LAB: \n \nExercise protocol: ___ \n___ heart rate: 56 \nResting blood pressure: 122/80 \nExercise Duration: 8 min \nPeak heart rate: 112 \nPercent maximum predicted heart rate obtained: 71% \nPeak blood pressure: 178/80 \nSymptoms during exercise: Vague midsternal chest "feeling," not \n"discomfort" \nReason exercise terminated: Fatigue \nECG findings: Equivocal 0.5 mm STD, resolved by 10 min \n \nMETHOD: \n \nResting perfusion images were obtained with Tc-99m sestamibi. \nTracer was \ninjected approximately 45 minutes prior to obtaining the resting \nimages. \n \nAt peak exercise, approximately three times the resting dose of \nTc-99m sestamibi \nwas administered IV. Stress images were obtained approximately \n15 minutes \nfollowing tracer injection. \n \nImaging Protocol: Gated SPECT \n \nThis study was interpreted using the 17-segment myocardial \nperfusion model. \n \nINTERPRETATION: \n \nThe image quality is adequate. \n \nLeft ventricular cavity size is normal. \n \nResting and stress perfusion images reveal uniform tracer uptake \nthroughout the left ventricular myocardium. \n \nGated images reveal normal wall motion. \n \nThe calculated left ventricular ejection fraction is 59%. \n \nCompared with the study of ___, there is no significant \nchange. \n\nIMPRESSION: No abnormalities at level of exercise achieved.\n___ yo female with HTN, HL, h/o CAD s/p DES to RCA in ___ p/w \njaw pain, palpitations.\n.\n# Jaw discomfort/palpitations: Given history, concern for \nangina/ischemia. Low suspicion for ACS given lack of ECG \nchanges, trop negative x 3. Other etiologies of \npalpitations/jaw discomfort included transient SVT, e.g. AVRT \nvs. AVNRT, or paroxysmal a. fib. Telemetry overnight revealed \nparoxysmal atrial fibrillation, and patient had complained of \npalpitations overnight. Ischemic evaluation was performed, with \nnormal results noted above. Full dose ASA, statin, and \nezetimibe were continued. Lipid panel showed LDL 125 following \ndischarge. At discharge, PAF was thought to be etiology of \npatient\'s presentation. CHADS2 score of 1 (HTN). She was \ndischarged with ___ of Hearts monitor, continued on ASA and \natenolol. Her valsartan was increased to 320 mg for improved BP \ncontrol, as SBP were generally 140s-150s mmHg. Dr. ___ \nfollow up the patient\'s ___ results.\n.\n# Hypertension- Hypertensive upon admission today. \nAsymptomatic. Initially continued home valsartan, atenolol. \nIncreased valsartan at time of discharge as noted above.\n.\n# h/o GERD- continued PPI\n.\nFEN: no IVF/replete lytes/cardiac diet\n.\nACCESS: PIV\n.\nCODE: full \n.\nCOMM: ___, husband, ___'}}
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{'final_diagnoses': ['Paroxysmal atrial fibrillation', 'Hypertension', 'Hyperlipidemia'], 'procedures': ['none'], 'visit_summary': "___ yo female with HTN, HL, h/o CAD s/p DES to RCA in ___ p/w \njaw pain, palpitations.\n.\n# Jaw discomfort/palpitations: Given history, concern for \nangina/ischemia. Low suspicion for ACS given lack of ECG \nchanges, trop negative x 3. Other etiologies of \npalpitations/jaw discomfort included transient SVT, e.g. AVRT \nvs. AVNRT, or paroxysmal a. fib. Telemetry overnight revealed \nparoxysmal atrial fibrillation, and patient had complained of \npalpitations overnight. Ischemic evaluation was performed, with \nnormal results noted above. Full dose ASA, statin, and \nezetimibe were continued. Lipid panel showed LDL 125 following \ndischarge. At discharge, PAF was thought to be etiology of \npatient's presentation. CHADS2 score of 1 (HTN). She was \ndischarged with ___ of Hearts monitor, continued on ASA and \natenolol. Her valsartan was increased to 320 mg for improved BP \ncontrol, as SBP were generally 140s-150s mmHg. Dr. ___ \nfollow up the patient's ___ results.\n.\n# Hypertension- Hypertensive upon admission today. \nAsymptomatic. Initially continued home valsartan, atenolol. \nIncreased valsartan at time of discharge as noted above.\n.\n# h/o GERD- continued PPI\n.\nFEN: no IVF/replete lytes/cardiac diet\n.\nACCESS: PIV\n.\nCODE: full \n.\nCOMM: ___, husband, ___", 'medications_prescribed': ['1. Pravastatin 20 mg Tablet Sig: Four (4) Tablet PO DAILY \n(Daily).', '2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '3. Valsartan 320 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', '5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', '7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'F', 'symptoms': 'Cellulitis', 'medical_history': ['Crystal Meth abuse'], 'family_history': 'Non-contributory', 'present_illness': "Patient is a ___ year-old male with a past medical history of \ncrystal meth abuse presenting to the ED from ___'s office \nyesterday with worsening cellulitis on the right upper back. \nPatient initially began to notice pain and erythema in the area \nlast ___ associated with generalized weakness. He denied \nany fevers or chills and other systemic symtpoms at the time. \nHe states that he uses clippers to groom his back often and did \nnot clean them prior to the last use. He was seen in ___'s \noffice on ___, who prescribed Bactrim. He presented again on \n___ with worsening pain, burning sensation, and increased \nswelling despite taking antibiotics. He was thus sent to the ED \nfor concern of possible abscess formation.\n. \nIn the ED, initial vs were: 96.4 82 135/73 18 100% RA. On \ninitial exam, there was no palpable fluctuance or abscess seen \non bedside ultrasound. He was given a dose of IV Vancimycin and \nplaced in Obs overnight. This morning, he was febrile with \nerythema extending beyond the borders drawn overnight. A \nfluctuance was also seen with a small pustule. The fluctuance \nI+D'ed in the ED and drained blood with some pus, per the \npatient's report. Patient was given 2 doses of IV Vanco, 15 mg \nOxycodone, Morphine 4mg IV, Ketorolac 30mg IV. On transfer, \nvital signs were 95 112/67 96% RA.\n. \nOn the floor, patient is febrile to 101, but feeling better \ncompared to last night.\n. \nReview of sytems: \n(+) Per HPI \n(-) Denies night sweats, recent weight loss or gain. Denies \nheadache, sinus tenderness, rhinorrhea or congestion. Denied \ncough, shortness of breath. Denied chest pain or tightness, \npalpitation. Denied nausea, vomiting, diarrhea, constipation or \nabdominal pain. No recent change in bowel or bladder habits. No \ndysuria. Denied arthralgias or myalgias. ", 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': '3X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (EXTended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mult', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Valproate Sodium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Flumazenil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Divalproex (EXTended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 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'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 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'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '334', 'valuenum': 334.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '365', 'valuenum': 365.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 357.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 165.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '___', 'valuenum': 0.31, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 48.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 43.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '1.00', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 163.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '>50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.021', 'valuenum': 1.021, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Hazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '636', 'valuenum': 636.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '898', 'valuenum': 898.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 20.4, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 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'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.39', 'valuenum': 2.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MOD.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.005', 'valuenum': 1.005, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.53', 'valuenum': 2.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.59', 'valuenum': 2.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 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'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.2', 'valuenum': 46.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.05, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.05, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '367', 'valuenum': 367.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.35', 'valuenum': 2.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '324', 'valuenum': 324.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.18', 'valuenum': 2.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 39.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS. ANION GAP VERIFIED.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '338', 'valuenum': 338.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.30', 'valuenum': 2.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '169', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 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'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '476', 'valuenum': 476.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.07', 'valuenum': 2.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '460', 'valuenum': 460.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.15', 'valuenum': 2.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '604', 'valuenum': 604.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.31', 'valuenum': 2.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = 66 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'ug/mL', 'ref_range_lower': 50.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY INCREASES THIS RESULT.'}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '511', 'valuenum': 511.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.64', 'valuenum': 2.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.8', 'valuenum': 67.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '556', 'valuenum': 556.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.6', 'valuenum': 21.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.61', 'valuenum': 2.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 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'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '383', 'valuenum': 383.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.9', 'valuenum': 19.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.61', 'valuenum': 2.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.49', 'valuenum': 2.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.54', 'valuenum': 2.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: 101 116/70 90 18 98% RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema\nNeuro: CNs2-12 intact, motor function grossly normal \nSkin: Right upper back with 5x7 cm erythematous and tender \nfluctuance, I+D site packed, surrounding erythema', 'diagnoses': [{'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '2639', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '514', 'desc': 'Pulmonary congestion and hypostasis'}, {'icd_code': '3313', 'desc': 'Communicating hydrocephalus'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '0414', 'desc': 'Escherichia coli [E. coli] infection in conditions classified elsewhere and of unspecified site'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '7580', 'desc': "Down's syndrome"}, {'icd_code': '3310', 'desc': "Alzheimer's disease"}, {'icd_code': '29410', 'desc': 'Dementia in conditions classified elsewhere without behavioral disturbance'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '7837', 'desc': 'Adult failure to thrive'}, {'icd_code': '7823', 'desc': 'Edema'}, {'icd_code': '2512', 'desc': 'Hypoglycemia, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': "ADMISSION LABS:\n.\n___ 06:40PM BLOOD WBC-11.9*# RBC-4.72 Hgb-15.4 Hct-43.3 \nMCV-92 MCH-32.7* MCHC-35.6* RDW-12.9 Plt ___\n___ 06:40PM BLOOD Neuts-78.5* Lymphs-15.9* Monos-3.7 \nEos-1.6 Baso-0.4\n___ 06:40PM BLOOD Glucose-150* UreaN-19 Creat-1.3* Na-136 \nK-5.0 Cl-100 HCO3-25 AnGap-16\n___ 06:43PM BLOOD Lactate-2.5*\n___ year old male with a history of crystal meth abuse presenting \nwith cellulitis and abscess that has worsened despite PO \nantibitoics.\n. \n#. Cellulitis/MRSA Abscess: Patient was maintained on vancomycin \nfor 4 days worth of IV antibitoics. He remained afebrile. \nWound culture grew 1+ GPC inc clusters. Blood cultures showed \nNGTD by discharge. He had one I+D in the ED on admission, and \nhad another I+D by surgery on ___/. He was discharged on 10 days \nof bactrim/keflex, wound care ___ for dressing changes, and PCP \nand surgery ___.\n.\n#. Pain control: Patient's pain controlled with tyelnol and PRN \noxycodone during admission. "}}
|
{'final_diagnoses': ['methicillin resistant staphylococcus aureus skin \ninfection'], 'procedures': ['Incision and drainage'], 'visit_summary': "___ year old male with a history of crystal meth abuse presenting \nwith cellulitis and abscess that has worsened despite PO \nantibitoics.\n. \n#. Cellulitis/MRSA Abscess: Patient was maintained on vancomycin \nfor 4 days worth of IV antibitoics. He remained afebrile. \nWound culture grew 1+ GPC inc clusters. Blood cultures showed \nNGTD by discharge. He had one I+D in the ED on admission, and \nhad another I+D by surgery on ___/. He was discharged on 10 days \nof bactrim/keflex, wound care ___ for dressing changes, and PCP \nand surgery ___.\n.\n#. Pain control: Patient's pain controlled with tyelnol and PRN \noxycodone during admission. ", 'medications_prescribed': ['sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: Two (2) \nTablet PO BID (2 times a day) for 10 days.\nDisp:*40 Tablet(s)* Refills:*0*', 'cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every \n6 hours) for 10 days.\nDisp:*40 Capsule(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'F', 'symptoms': 'painful contractions', 'medical_history': ['PNC: \n - ___ ___ by ___\n - Labs ___ pos/Abs neg/Rub I/RPR NR/HBsAg neg/HIV neg /GBS unk\n - Screening low risk ___, male \n - FFS no issues \n - GLT normal \n - U/S ___ EFW 1025g, 52%ile, BPP ___ anterior placenta\n - Issues: \n*) Hypothyroid, on Levoxyl 125 mcg qd, TSH 0.68 on ___. \n*) Patient is a muscular dystrophy ___ has MD. ___\nshowed this pregnancy male, so has a 50% chance of being\naffected. s/p genetics consult; declines prenatal diagnosis. \nPlan\nrpt US at 32 weeks\n*) Hx of primary C/S for arrest of dilatation and repeat C/S \nwith\nsignificant scar tissue. Patient would like rpt C/S- scheduled\n___. \n*) BC: patient would like PPTL with C/S.', 'hypothyroidism as above'], 'family_history': None, 'present_illness': '___ G3P2 at ___ who presents with regular painful\ncontractions that started around ___. They were previously \nevery\n___ minutes at home and now are much closer together, with only\napproximately 90 seconds in between. She rates them at a ___\nand has to breathe through each one. She otherwise denies any \nVB,\nno LOF, +AFM.', 'medications': [{'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '311', 'valuenum': 311.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '318', 'valuenum': 318.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.55', 'valuenum': 4.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '316', 'valuenum': 316.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.27', 'valuenum': 4.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Physical Exam\n ___ 22:34Temp.: 98.5°F\n___ 22:35Resp.: 20 / min\n___ 22:35BP: 125/80 (90)\n___ ___: 88\nGen: uncomfortable during contractions, otherwise NAD\nAbd: gravid, nontender, intermittent palpable ctx\nSSE: cervix visually closed, no pooling, no abnl discharge, no\nbleeding\nSVE (at 2330): FT/50/mid position\nFHT: 135/mod var/+accels/-decels \nToco: q2-3 mins', 'diagnoses': [{'icd_code': '566', 'desc': 'Abscess of anal and rectal regions'}, {'icd_code': '56942', 'desc': 'Anal or rectal pain'}], 'summary': '___ 12:01AM BLOOD WBC-9.1 RBC-3.66* Hgb-11.1* Hct-33.3* \nMCV-91 MCH-30.3 MCHC-33.3 RDW-13.4 RDWSD-45.1 Plt ___\n___ 12:01AM URINE Color-Straw Appear-Clear Sp ___\n___ 12:01AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG\n___ 12:30AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG oxycodn-NEG mthdone-NEG\n___ 12:33AM OTHER BODY FLUID FetalFN-NEGATIVE\n___ 11:42 pm SWAB Site: VAGINA\n\n **FINAL REPORT ___\n\n Chlamydia trachomatis, Nucleic Acid Probe, with Amplification \n(Final\n ___: Negative for Chlamydia trachomatis by \nPANTHER System,\n APTIMA COMBO 2 Assay. \n\n NEISSERIA GONORRHOEAE (___), NUCLEIC ACID PROBE, WITH \nAMPLIFICATION\n (Final ___: Negative for Neisseria gonorrhoeae by \nPANTHER\n System, APTIMA COMBO 2 Assay. \n___ 11:42 pm SWAB Site: VAGINA\n\n **FINAL REPORT ___\n\n SMEAR FOR BACTERIAL VAGINOSIS (Final ___: \n GRAM STAIN NEGATIVE FOR BACTERIAL VAGINOSIS.\n___ G3P2 at ___ who was admitted with preterm contractions. \nHer cervical exam was stable at fingertip/50/mid-position/soft \nover several hours. She had a negative FFN, negative UA, and \nnegative UTox. She had no evidence of abruption or infection. \nShe did not receive betamethasone. She was continued on \nhypothyroidism. She had a formal ultrasound on ___ AM with \nappropriate growth. Her contractions improved and she was \ndischarged home for outpatient follow up.'}}
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{'final_diagnoses': ['Preterm contractions', 'Hypothyroidism'], 'procedures': ['none'], 'visit_summary': '___ G3P2 at ___ who was admitted with preterm contractions. \nHer cervical exam was stable at fingertip/50/mid-position/soft \nover several hours. She had a negative FFN, negative UA, and \nnegative UTox. She had no evidence of abruption or infection. \nShe did not receive betamethasone. She was continued on \nhypothyroidism. She had a formal ultrasound on ___ AM with \nappropriate growth. Her contractions improved and she was \ndischarged home for outpatient follow up.', 'medications_prescribed': ['Levothyroxine Sodium 125 mcg PO DAILY', 'Prenatal Vitamins 1 TAB PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 47, 'gender': 'F', 'symptoms': 'Abdominal pain with nausea and vomiting', 'medical_history': ['HIV- refusing ARVs per ID note', 'ESRD on HD ___ HTN)', 'RUE AVG, ligated ___', 'Hep C', 'HTN', 'Liver biopsy- ___ showed focal mild-to-moderate portal \nchronic inflammation with focal periportal extension (grade II).', 'ECHO ___: EF> 55% some thickening on the aortic valve', 'Diverticulosis', 'High-grade adenomatous polyp'], 'family_history': 'non-contributory', 'present_illness': '___ F with HIV, ESRD on HD, hepC, HTN who developed nausea, \nvomiting and abdominal pain yesterday after being dialyzed. She \nvomited once on her way home from dialysis and has not vomited \nsince. She notes that she has been constipated since her \nadmission two weeks ago for fistula placement. She takes \npercocet daily for pain control, and was on additional pain \nmedication during her recent admission. She has had a bowel \nmovement since her admission, but only in small amounts and \ninfrequently. She does not think she has had a bowel movement \nfor 1 week. \n She describes the pain as diffuse, crampy and intermittent, \n___ at its worst. She denies fever, chills, chest pain, SOB. \nShe makes small amount of urine and denies any dysuria.', 'medications': [{'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Clobazam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Clobazam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clobazam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Cepacol (Menthol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Keppra', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Keppra', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '4', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '405', 'valuenum': 405.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70.4', 'valuenum': 70.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '305', 'valuenum': 305.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission PE:\nVS: T 97.8 BP 156/93 HR 67 RR 14 pOx 96 RA Wt 117.2 lb \nGENERAL: non-toxic, NAD \nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. \nNECK: Supple \nHEART: RRR, no RG, +SEM, nl S1-S2. \nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. \n\nABDOMEN: tenderness mostly in LUQ, distended, no masses or HSM, \nno rebound/guarding. \nEXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses. RUE graft is \ncovered with ACE bandage, unable to assess if bruit. \nSKIN: No rashes or lesions. \nLYMPH: No cervical LAD. \nNEURO: Awake, A&Ox3, CNs III-XII intact, muscle grossly intact \n\nDischarge PE:\nHemodynamically stable, afebrile.\nRight arm graft nonerythematous, not warm, midly tender to \npalpation.\nAbdomen soft, NT, ND, +BS\nExam otherwise unchanged.', 'diagnoses': [{'icd_code': '34511', 'desc': 'Generalized convulsive epilepsy, with intractable epilepsy'}, {'icd_code': '34551', 'desc': 'Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy'}, {'icd_code': '3899', 'desc': 'Unspecified hearing loss'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '78060', 'desc': 'Fever, unspecified'}, {'icd_code': '326', 'desc': 'Late effects of intracranial abscess or pyogenic infection'}], 'summary': '___ 06:55AM GLUCOSE-82 UREA N-21* CREAT-6.2*# SODIUM-138 \nPOTASSIUM-3.8 CHLORIDE-90* TOTAL CO2-35* ANION GAP-17\n___ 06:55AM LIPASE-20\n___ 06:55AM PHOSPHATE-4.4# MAGNESIUM-2.3\n___ 06:55AM WBC-5.1 RBC-3.71* HGB-11.5* HCT-35.2* MCV-95 \nMCH-31.1 MCHC-32.8 RDW-14.8\n___ 06:55AM PLT COUNT-263\n___ 08:26PM LACTATE-1.5\n___ 08:25PM ALT(SGPT)-20 AST(SGOT)-34 ALK PHOS-130* TOT \nBILI-0.4\n___ 08:25PM ALBUMIN-4.2 CALCIUM-10.5* PHOSPHATE-2.3*# \nMAGNESIUM-1.8\n\nCT Abdomen/Pelvis w/o contrast (___): 1. No evidence of \nbowel obstruction, colitis/diverticulitis, bowel ischemia, or \nother acute process. Moderate colonic fecal loading, which could \nbe a source of pain. \n2. Polycystic kidneys, essentially unchanged in appearance from \n___. \n3. Cholelithiasis, without CT evidence of cholecystitis. \n4. Extensive aortoiliac atherosclerosis. Vessel patency not \nassessed without contrast. \n5. Diffuse peritoneal calcifications, unchanged. \n6. Osseous findings compatible with renal osteodystrophy. \n\nECG (___)- Normal sinus rhythm, no ST-T wave abnormalities.\n\nKUB (___)- Large amount of fecal material in the colon. No \nsigns of free air or obstruction.\n___ yo female with HIV, ESRD on HD, HepC and HTN who presented \nwith abdominal pain due to constipation.\n\n#Constipation- Patient has been on increased narcotics following \nrecent right fistula procedure. She had only gone to the \nbathroom once following discharge 2 weeks ago. Abdominal exam \nshowed distension without rebound or guarding. CT abdomen \nshowed stool throughout the colon without evidence of \nobstruction or ischemia. Nor was there evidence of \ncholecystitis or pancreatitis. Patient was started on an \naggressive bowel regimen including senna, colace, miralax, and \nsoap ___ enemas. The patient did not have bowel movements with \nthis regimen, and so lactulose, golytely and methylnaltrexone \nwas added. Patient had good bowel movements, which resulted in \nrelief of abdominal pain. Patient was discharged on senna, \ncolace, miralax, and lactulose but did not think she would need \nthem as hospital and medications that caused her constipation \nwould no longer be present. \n\n#ESRD- Patient missed her ___ HD as her abdominal pain was \ntoo severe. Her electrolytes were closely followed and stable. \nShe was dialyzed the following day, on the day of discharge.\n\n#HIV/HepC- Patient was continued on HAART regimen throughout \nadmission in addition to bactrim prophylaxis. \n\n#HTN- BP was stable throughout admission. Patient had no \ncomplaints of chest pain. Patient was continued on metoprolol, \nlisinopril, and aspirin.'}}
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{'final_diagnoses': ['Constipation'], 'procedures': ['None.'], 'visit_summary': '___ yo female with HIV, ESRD on HD, HepC and HTN who presented \nwith abdominal pain due to constipation.\n\n#Constipation- Patient has been on increased narcotics following \nrecent right fistula procedure. She had only gone to the \nbathroom once following discharge 2 weeks ago. Abdominal exam \nshowed distension without rebound or guarding. CT abdomen \nshowed stool throughout the colon without evidence of \nobstruction or ischemia. Nor was there evidence of \ncholecystitis or pancreatitis. Patient was started on an \naggressive bowel regimen including senna, colace, miralax, and \nsoap ___ enemas. The patient did not have bowel movements with \nthis regimen, and so lactulose, golytely and methylnaltrexone \nwas added. Patient had good bowel movements, which resulted in \nrelief of abdominal pain. Patient was discharged on senna, \ncolace, miralax, and lactulose but did not think she would need \nthem as hospital and medications that caused her constipation \nwould no longer be present. \n\n#ESRD- Patient missed her ___ HD as her abdominal pain was \ntoo severe. Her electrolytes were closely followed and stable. \nShe was dialyzed the following day, on the day of discharge.\n\n#HIV/HepC- Patient was continued on HAART regimen throughout \nadmission in addition to bactrim prophylaxis. \n\n#HTN- BP was stable throughout admission. Patient had no \ncomplaints of chest pain. Patient was continued on metoprolol, \nlisinopril, and aspirin.', 'medications_prescribed': ['1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '2. raltegravir 400 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', '3. ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily).', '4. atazanavir 300 mg Capsule Sig: One (1) Capsule PO once a day.', '5. lamivudine 25 mg/5 mL (5 mg/mL) Solution Sig: One (1) PO \nonce a day.', '6. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.', '7. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID \nW/MEALS (3 TIMES A DAY WITH MEALS).', '8. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for constipation.\nDisp:*30 Tablet(s)* Refills:*1*', '9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', '10. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) \nTablet PO QMOWEFR (___).', '11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H \n(every 6 hours) as needed for pain.', '12. metoprolol tartrate 100 mg Tablet Sig: One (1) Tablet PO \ntwice a day.', '13. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) \ndose PO once a day.\nDisp:*1 bottle* Refills:*2*', '14. lactulose 10 gram/15 mL Solution Sig: One (1) dose PO once a \nday as needed for constipation.\nDisp:*10 doses* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'M', 'symptoms': 'elevated blood pressures\nPUPPS\ndi-di twin pregnancy', 'medical_history': ['PNC:', '- ___ ___ by LMP c/w ___ tri U/S', '- Labs Rh pos/Abs neg/Rub I/RPR NR/HBsAg neg/HIV neg/GBS neg on\n___', '- LR ERA x2', '- FFS FFS wnl x2', '- GLT nl', '- U/S ___ A vtx EFW 2597 g 24%, B vtx EFW 2929 g 50%, 11.2%\ndiscordance, vtx/transverse', '- Issues\n* on baby ASA for twins\n* neg baseline PIH labs\n* PUPPS', 'OBHx:\n- G1', 'GynHx:\n- abnormal Pap, fibroids, Gyn surgery, STIs', 'PMH: \n- Anxiety', "PSH: \n- Bilateral breast augmentation (told 50% chance won't be able \nto\nbreastfeed)"], 'family_history': None, 'present_illness': '___ yo G1P0 at 36\'5 with di-di twins admitted for rule out\npre-eclampsia. She presented to ___ today and reported a mild\nheadache and one episode of "flashing light" in her vision. She\nattributes these to sleep deprivation as she was unable to sleep\nlast night. She otherwise feels well. She had normal PIH labs at\n___ and P:C ratio of 0.5. She was sent to triage for further\nevaluation and admission for 24 hour urine collection.', 'medications': [{'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nadolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '355', 'valuenum': 355.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '390', 'valuenum': 390.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC, MODERATELY.'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 2.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREENTOP.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 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'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '216', 'valuenum': 216.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '338', 'valuenum': 338.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 18.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC.'}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.75', 'valuenum': 2.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '333', 'valuenum': 333.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SM .'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '291', 'valuenum': 291.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam\nVitals: ___ 21:36BP: 131/86 (96)\n___ ___: 84\n___ 21:44BP: 133/98 (105)\n___ ___: 90\n\nGen: A&O, comfortable\nPulm: nl work of breathing\nAbd: soft, gravid, nontender\n\nExt: no calf tenderness\n\nFHT A- 130/mod var/+accels/-decels\n B- 130/mod var/+accels/-decels\nToco: no ctx\n.\n.\n.\nDischarge Physical Exam \nOBJECTIVE:\nTc BP HR RR SpO2\n\n___ Temp: 98.1q PO BP: 133/74 HR: 84 RR: 18 O2 sat: \n98%\nO2 delivery: RA Pain Score: ___\n___ 1630 Temp: 98.3 PO BP: 139/84 HR: 75 RR: 18 O2 sat: 99%\nO2 delivery: RA \n\nGeneral: NAD, A&Ox3\nBreasts: non-tender, no erythema, soft, nipples intact\nLungs: No respiratory distress\nAbd: soft, nontender, fundus firm below umbilicus\nIncision: steri strips clean/dry/intact, nontender, no\nsurrounding erythema or drainage\nSkin: urticarial plaques and papules surrounding umbilicus\ncontinue in same distribution as day prior. additional vesicles\nseen across the b/l wrist, ankles, as well as dorsum of\nfeet and buttocks. \nLochia minimal\nExtremities: no calf tenderness', 'diagnoses': [{'icd_code': '5722', 'desc': 'Hepatic encephalopathy'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '29181', 'desc': 'Alcohol withdrawal'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '5723', 'desc': 'Portal hypertension'}, {'icd_code': '25002', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '28529', 'desc': 'Anemia of other chronic disease'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': '___ 11:42PM URINE HOURS-RANDOM CREAT-49 TOT PROT-33 \nPROT/CREA-0.7*\n___ 11:42PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 11:42PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30* \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-MOD*\n___ 11:42PM URINE RBC-0 WBC-8* BACTERIA-MOD* YEAST-NONE \nEPI-2 TRANS EPI-<1\n___ 10:00PM CREAT-0.8\n___ 10:00PM estGFR-Using this\n___ 10:00PM ALT(SGPT)-23 AST(SGOT)-33\n___ 10:00PM URIC ACID-8.8*\n___ 10:00PM WBC-8.2 RBC-3.___\nHGB-10.0* HCT-29.6* MCV-96 \nMCH-32.6* MCHC-33.8 RDW-12.5 RDWSD-43.0\n___ 10:00PM PLT COUNT-168\n___ 09:55PM URINE HOURS-RANDOM CREAT-34 TOT PROT-28 \nPROT/CREA-0.8*\n___ 10:09AM BLOOD ALT-27 AST-38\n___ 07:55PM BLOOD Glucose-73 UreaN-8 Creat-0.8 Na-137 K-4.6 \nCl-102 HCO3-22 AnGap-13\n___ 07:55PM BLOOD ___ PTT-30.9 ___\n___ 10:09AM BLOOD WBC-8.4 RBC-3.33* Hgb-11.0* Hct-32.8* \nMCV-99* MCH-33.0* MCHC-33.5 RDW-12.6 RDWSD-44.9 Plt ___\n___ 07:20AM BLOOD WBC-15.5* RBC-2.45* Hgb-8.2* Hct-23.9* \nMCV-98 MCH-33.5* MCHC-34.3 RDW-12.5 RDWSD-44.5 Plt ___\nOn ___, Ms. ___ was admitted to the antepartum service at \n36wk5d with di-di twins with gestational hypertension for rule \nout preeclampsia evaluation. On admission her serum PIH labs \nwere normal and urine P:C 0.7. She was started on 24 hour urine \ncollection. For her history of PUPPS she was started on benadryl \nand sarna for symptom control. \n\nOn ___ she had spontaneous rupture of membranes and was \ntransferred to L&D for further management. \n\nShe subsequently underwent a pLTCS for arrest of descent c/b \nPEC, PPH, and worsening PUPPS. \n\n#: PPH: patient with total EBL 1400cc (800cc delivery + 600cc in \npostpartum) due to uterine atony after visualization of the \ncervix revealed no abnormalities. Please see op report for full \ndetails. Patient received PP pitocin, cytotec and TXA for PPH. \npre and post op hct were obtained which were stable. \n\n#: PRE-eclampsia: patient was found to have pre-eclampsia with \nmild range BPs and a urine P/C of 0.7. She remained with normal \nto mild range BPs not needing medication during her admission. \n\n#: PUPPS: On admission to antepartum, patient was diagnosed with \nPUPPS, was given benadryl, sarna and hydrocortisone cream with \nworsening symptoms. A dermatology consult was ordered with \nrecommendations for clobetasol 0.05% ointment BID w/ seran wrap.\n\nBy postpartum day 4, she was tolerating a regular diet, \nambulating independently, and pain was controlled with oral \nmedications. She was afebrile with stable vital signs. She was \nthen discharged home in stable condition with postpartum \noutpatient follow-up scheduled.'}}
|
{'final_diagnoses': ['primary C/S of twins', 'PUPPS', 'preeclampsia'], 'procedures': ['primary LTCS'], 'visit_summary': 'On ___, Ms. ___ was admitted to the antepartum service at \n36wk5d with di-di twins with gestational hypertension for rule \nout preeclampsia evaluation. On admission her serum PIH labs \nwere normal and urine P:C 0.7. She was started on 24 hour urine \ncollection. For her history of PUPPS she was started on benadryl \nand sarna for symptom control. \n\nOn ___ she had spontaneous rupture of membranes and was \ntransferred to L&D for further management. \n\nShe subsequently underwent a pLTCS for arrest of descent c/b \nPEC, PPH, and worsening PUPPS. \n\n#: PPH: patient with total EBL 1400cc (800cc delivery + 600cc in \npostpartum) due to uterine atony after visualization of the \ncervix revealed no abnormalities. Please see op report for full \ndetails. Patient received PP pitocin, cytotec and TXA for PPH. \npre and post op hct were obtained which were stable. \n\n#: PRE-eclampsia: patient was found to have pre-eclampsia with \nmild range BPs and a urine P/C of 0.7. She remained with normal \nto mild range BPs not needing medication during her admission. \n\n#: PUPPS: On admission to antepartum, patient was diagnosed with \nPUPPS, was given benadryl, sarna and hydrocortisone cream with \nworsening symptoms. A dermatology consult was ordered with \nrecommendations for clobetasol 0.05% ointment BID w/ seran wrap.\n\nBy postpartum day 4, she was tolerating a regular diet, \nambulating independently, and pain was controlled with oral \nmedications. She was afebrile with stable vital signs. She was \nthen discharged home in stable condition with postpartum \noutpatient follow-up scheduled.', 'medications_prescribed': ['Clobetasol Propionate 0.05% Ointment 1 Appl TP BID \nRX *clobetasol 0.05 % apply to effected area as instructed in \nthe hospital twice a day Refills:*2', 'Docusate Sodium 100 mg PO BID:PRN Constipation \nRX *docusate sodium 100 mg 1 (One) capsule(s) by mouth twice a \nday Disp #*20 Capsule Refills:*0', 'Ibuprofen 600 mg PO Q6H:PRN Pain \nRX *ibuprofen 600 mg 1 (One) tablet(s) by mouth every six (6) \nhours Disp #*50 Tablet Refills:*0']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'F', 'symptoms': 'transfer from ___ for anhydramnios', 'medical_history': ['OB Hx:\n___: SAB 10wks\n___: LTCS, failed IOL, girl', 'PMHx:\nAcid Base Ulcer Disease\nCrohns Disease \nOpioid dependance', 'PSHx:\n___: LTCS, term, failed IOL\nEx lap and repair of duodenal ulcer ___, ___\nEx lap, selective vagotomy, appendectomy, cholecystectomy, ___,', 'CHA\nLTCS'], 'family_history': None, 'present_illness': 'Pt is a ___ y/o G3P1 @ 36wks by ___ US presenting via ambulance\ntransfer from ___ for a new finding of anhydramnios \nin\nthe setting of maternal motrin use. She reports she has been\ngetting routine prenatal care at ___ (Dr.\n___. Per report over the past 2wks she reports she\nstarted to use 400mg motrin BID at the recommendation of her OB\nfor a recent sore right ankle. She reports she presented to\n___ today because she was concerned that she has not\nhad an US since ___. \n\nAt ___ today she underwent an US showing \nanhydramnios,\n?absent kidneys, no fluid filled stomach and no bladder. She \nhad\na BPP ___ (no fluid). Then she was transferred to ___\n\nAt ___, she reports she feels overall well. She denies any\nLOF, VB, contractions. She reports the fetus is moving \nnormally.\nShe denies any fevers, chills, cough, CP/SOB/abdominal pain.\n\nDating:\n___ ___ by 6wks US\n\nAnatomy US at 18wk, normal appearing, limited views of outflow\ntracks, 3VC, kidneys normal', 'medications': [{'medication': 'Prenatal Vitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prenatal Vitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '222', 'valuenum': 222.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '245', 'valuenum': 245.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mIU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 100000.0, 'flag': None, 'priority': 'STAT', 'comments': 'Values <5 are negative. values 5-25 are Equivocal. values >25 are Positive.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.3', 'valuenum': 38.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 168.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.27', 'valuenum': 1.27, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76.1', 'valuenum': 76.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.54', 'valuenum': 3.54, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.12', 'valuenum': 0.12, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.78', 'valuenum': 0.78, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.13', 'valuenum': 7.13, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Positive. Titer is between 100 and 500 mIU/mL. Protective titers are greater than >10.0 mIU/mL.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Negative.'}, {'value': '0.404', 'valuenum': 0.404, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '343.7', 'valuenum': 343.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.035', 'valuenum': 0.035, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.23', 'valuenum': 1.23, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76.9', 'valuenum': 76.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.19', 'valuenum': 0.19, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.63', 'valuenum': 0.63, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.10', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'On admission\n98.3, 65, 18, 137/___ppearing\n+s1s2\nCTA B/L\nWell healed vertical midline incision, well healed ___\nincision.\nNo epigastric tenderness\nNo fundal tenderness\nNormal appearing external female genitalia, no lesions\nNo pool, cervix closed appearing, normal appearing physiologic\ndischarge\nNo ferns, Nitrazine negative\n\nOn Discharge:\nAfebrile, VSS\nGen: NAD\nCV: RRR\nPulm: CTAB\nAbd: soft, appropriately tender, fundus firm, no R/G\nExt: no TTP\nIncision: ___ c/d/i', 'diagnoses': [{'icd_code': 'O046', 'desc': 'Delayed or excessive hemorrhage following (induced) termination of pregnancy'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'N979', 'desc': 'Female infertility, unspecified'}, {'icd_code': 'O021', 'desc': 'Missed abortion'}, {'icd_code': 'Q2732', 'desc': 'Arteriovenous malformation of vessel of lower limb'}], 'summary': "___ 7:30 pm ANORECTAL/VAGINAL CULTURE\n Source: Anorectal/Vaginal. \n\n **FINAL REPORT ___\n\n R/O GROUP B BETA STREP (Final ___: \n NEGATIVE FOR GROUP B BETA STREP. \n\nBed US ___: cephalic, AFI zero, BPP ___ (no fluid) normal \nappear\nkidneys B/L, stomach not visualized, small bladder, 3VC, normal\nappearing four chamber, LVOT, RVOT, cord insertion. EFW 2951g\n\n___ 08:10PM BLOOD WBC-5.6 RBC-3.77* Hgb-9.7* Hct-28.8* \nMCV-77* MCH-25.7* MCHC-33.6 RDW-13.4 Plt ___\n___ 10:39PM BLOOD pO2-21* pCO2-45 pH-7.34* calTCO2-25 Base \nXS--2 Comment-CORD VEIN\n___ 10:34PM BLOOD pO2-17* pCO2-98* pH-7.03* calTCO2-28 Base \nXS--10\n___ 06:07AM BLOOD Hct-23.6*\n___ 08:46PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\nMS. ___ is a ___ yo G3P1 @ ___ by 6wk US who was \ntransferred from ___ for a new finding of \nanhydramnios in the setting of maternal NSAID use. Upon \nevaluation, there was no evidence of PPROM. The fetus was well \ngrown with ___ BPP. Given that the AFI was zero and a \ngestational age of ___ weeks, delivery was recommended. Risk and \nbenefits of delivery were reviewed with the patient. The \nrisk/benefits of TOLAC vs. LTCS was also discussed and the \npatient elected for a repeat LTCS. She was seen by NICU. Her \npost op pain medication was discussed with ___ PC \n(Dr. ___. \n\nShe underwent a LTCS on ___. Please see the operative \nnote for details\nFINDINGS:\n1. Live-born female infant delivered from the cephalic\n presentation.\n2. No appreciable amniotic fluid.\n3. Apparently intact placenta with 3-vessel cord.\n4. Normal tubes, ovaries, and uterus.\n\nShe was seen by chronic pain for her post partum pain \nmanagement. Her pain was initially managed with Dilaudid PCA and \nSubutex then transitioned to Dilaudid PO ___ q3h, \nacetaminophen and low dose ibuprofen. She had an otherwise \nuncomplicated post-partum course and remained hemodynamically \nstable. \n\nShe was discharged in stable condition on post partum day 6 with \na week's prescription of narcotic medication and outpatient \nfollow-up."}}
|
{'final_diagnoses': ['s/p repeat C/S, narcotic dependence'], 'procedures': ['repeat LTCS'], 'visit_summary': "MS. ___ is a ___ yo G3P1 @ ___ by 6wk US who was \ntransferred from ___ for a new finding of \nanhydramnios in the setting of maternal NSAID use. Upon \nevaluation, there was no evidence of PPROM. The fetus was well \ngrown with ___ BPP. Given that the AFI was zero and a \ngestational age of ___ weeks, delivery was recommended. Risk and \nbenefits of delivery were reviewed with the patient. The \nrisk/benefits of TOLAC vs. LTCS was also discussed and the \npatient elected for a repeat LTCS. She was seen by NICU. Her \npost op pain medication was discussed with ___ PC \n(Dr. ___. \n\nShe underwent a LTCS on ___. Please see the operative \nnote for details\nFINDINGS:\n1. Live-born female infant delivered from the cephalic\n presentation.\n2. No appreciable amniotic fluid.\n3. Apparently intact placenta with 3-vessel cord.\n4. Normal tubes, ovaries, and uterus.\n\nShe was seen by chronic pain for her post partum pain \nmanagement. Her pain was initially managed with Dilaudid PCA and \nSubutex then transitioned to Dilaudid PO ___ q3h, \nacetaminophen and low dose ibuprofen. She had an otherwise \nuncomplicated post-partum course and remained hemodynamically \nstable. \n\nShe was discharged in stable condition on post partum day 6 with \na week's prescription of narcotic medication and outpatient \nfollow-up.", 'medications_prescribed': ['Acetaminophen ___ mg PO Q4H:PRN Pain \nRX *acetaminophen [Acetaminophen Extra Strength] 500 mg ___ \ntablet(s) by mouth q4-6hr Disp #*60 Tablet Refills:*0', 'Docusate Sodium 100 mg PO BID:PRN Constipation \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*60 Capsule Refills:*3', 'HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain \nRX *hydromorphone 4 mg 1 tablet(s) by mouth q3hrs Disp #*60 \nTablet Refills:*0', 'Ibuprofen 400 mg PO Q4H:PRN pain \nRX *ibuprofen 400 mg 1 tablet(s) by mouth every four (4) hours \nDisp #*50 Tablet Refills:*1']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 63, 'gender': 'M', 'symptoms': 'Vomiting', 'medical_history': ["1. Melanoma that was resected in ___, it was a right shoulder \nmelanoma w/ sentinel lymph node biopsy neg and no chemo given. \nPresented with hemoptysis ___ found to have lung metastasis \ncausing post obstructive PNA but was evaluated by IP for stent \nand found to have no obstruction. Also had a right sided pleurex \ncatheter place for malignant effusion which has since been \nremoved. She had recurrent hemoptysis so had bronchial artery \nembolization on ___ and then started on XRT. also found to have \nbilateral PE's despite lovenox and IVC filter and was discharged \nto rehab on ___. She was then admitted ___ for cisplatin, \ndacarbazine and vinblastine regimen.", '2. HTN', '3. SVT vs ? paroxysmal atrial fibrillation, recent \nhospitalization thought to have AVNRT', '4. Lower extremity DVT initially on coumadin but recieved IVC \nfilter with recurrent hemoptysis and subsequent PE despite \nlovenox and filter', '5. C-section x3', '6. CCY', '7. tonsillectomy/adenoidectomy'], 'family_history': 'Brother - melanoma in ___. Mother with HTN, breast cancer @ ___ \nand has DMII. Father with MI in ___', 'present_illness': 'PCP: ___ is primary ONC\n\nHPI: ___ F in ER with HA for 2 weeks, nausea x 1 week, and \nintractable vomiting x 2 days. She has also noticed some \nincreasing cough and sinus pressure the last few days along with \ncough in the morning. Also started having diarrhea yesterday \nwhich has now stopped. She denies any f/c, SOB, chest pain. No \nchanges in her vision, no numbness, weakness. \n\nIn ER: Got symptomatic therapy. Omed fellow recommended CT of \nhead which did not reveal any mets. had an abd CT with no abd \npathology. 2L IVF given. Zofran given without success, patient \nstill vomiting.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Phenytoin (Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Esmolol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '-1', 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'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'VERY LOW.'}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63.2', 'valuenum': 63.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.68', 'valuenum': 3.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '214', 'valuenum': 214.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.1', 'valuenum': 48.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '291', 'valuenum': 291.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '(Per Admitting Resident)\nVS: 98.2 113/65 127 20 95RA\nGen: no acute distress, awake, alert, appropriate, and oriented \nx 3\nSkin: warm to touch, no apparent rashes. \nHEENT: No conjunctival pallor, no scleral jaundice, OP clear\nCV: RRR but tachy, no audible m/r/g\nLungs: clear to auscultation\nAbd: soft, NT, normal BS\nExt: No C/C/E\nNeuro: Gait, strength and sensation intact bilaterally.', 'diagnoses': [{'icd_code': '2910', 'desc': 'Alcohol withdrawal delirium'}, {'icd_code': '07054', 'desc': 'Chronic hepatitis C without mention of hepatic coma'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '920', 'desc': 'Contusion of face, scalp, and neck except eye(s)'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '37230', 'desc': 'Conjunctivitis, unspecified'}, {'icd_code': '7813', 'desc': 'Lack of coordination'}, {'icd_code': '79319', 'desc': 'Other nonspecific abnormal finding of lung field'}, {'icd_code': '29281', 'desc': 'Drug-induced delirium'}, {'icd_code': 'E8889'}, {'icd_code': 'E9394', 'desc': 'Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use'}], 'summary': "___ 11:35AM BLOOD ___ PTT-26.8 ___\n___ 11:35AM BLOOD Glucose-141* UreaN-7 Creat-1.0 Na-139 \nK-3.7 Cl-101 HCO3-20* AnGap-22*\n___ 11:35AM BLOOD ALT-81* AST-38 AlkPhos-118* TotBili-0.5\n___ 11:35AM BLOOD Lipase-26\n___ 05:03PM BLOOD CK-MB-2 cTropnT-<0.01\n___ 11:35AM BLOOD Calcium-9.7 Phos-2.6* Mg-1.5*\n___ 11:43AM BLOOD Lactate-2.6* Na-141\n\nDischarge Labs\n___ 05:31AM BLOOD WBC-10.9 RBC-3.57* Hgb-11.0* Hct-33.0* \nMCV-93 MCH-30.9 MCHC-33.4 RDW-14.7 Plt ___\n___ 03:48PM BLOOD Glucose-247* UreaN-15 Creat-1.1 Na-137 \nK-5.1 Cl-100 HCO3-29 AnGap-13\n___ 03:48PM BLOOD Calcium-8.5 Phos-2.9 Mg-2.3\n\nOther Labs\n___ 04:19AM BLOOD Prolact-5.8 TSH-0.059*\n___ 04:19AM BLOOD Free T4-0.91*\n___ 04:11AM BLOOD FSH-5.5 LH-1.7*\n___ 07:30AM BLOOD TSH-0.33\n___ 07:30AM BLOOD T4-4.6 T3-43* Free T4-0.72*\n\nBlood and Urine Cx - Negative\n\nRADIOLOGY\n\nCT A/P (___) - IMPRESSION: \n1. No acute intra-abdominal or pelvic pathology to explain the \npatient's symptoms. \n2. Left lower lobe vague nodular opacity for which the \ndifferential includes infectious versus neoplastic etiology. \nAttention on followup recommended. \n3. Mild decrease in size of right retroperitoneal/retrocaval \nmass. \n4. Colonic diverticulosis without evidence of acute \ndiverticulitis.\n\nCT Head (___) - IMPRESSION: No evidence of metastatic disease on \nthis limited non-contrast\nevaluation. Cutaneous nodules on the right are unchanged.\n\nECHO (___) - IMPRESSION: Suboptimal image quality. IMPRESSION: \nSuboptimal image quality. Normal biventricular cavity sizes with \npreserved global biventricular systolic function. No valvular \npathology or pathologic flow identified.\n\nBilateral Lower Ext U/S (___) - IMPRESSION: Limited exam of the \ndistal superficial femoral veins bilaterally due to body \nhabitus, but no evidence of DVT of either lower extremity.\n\nCT Chest (___) - IMPRESSION:\n1. Increased size of large right mediastinal and hilar masses, \nwith increased mass effect on the trachea, and worsening \nobstruction of the right middle lobe bronchus, and segmental \nright lower lobe bronchi. \n2. Findings most consistent with mild pulmonary edema, including \nnew small bilateral pleural effusions, scattered areas of \nground-glass opacity, and mild interlobular septal thickening.\n\nCT Head (___) - IMPRESSION:\nLimited evaluation of the pituitary gland. Possible enlargement \nof the pituitary gland currently measuring 10 x 10 mm and \npreviously measuring 7 x 10 mm on prior MR dated ___.\n___ y.o. Female with h.o. metastatic Melanoma to lungs, h.o. DVT \non Lovenox, presents with N/V/D and developed atrial flutter \nwith RVR. \n\n# N/V: Pt endorsed nausea over the past 2 weeks which lead to \nher admission as well as emesis x 3 days. Pt also endorses 3 \ndays of diarrhea, which resolved. Most likely dx is viral \ngastroenteritis. Head CT was negative for any masses. CT \nabd/pelvis was negative for any signs of intra-abdominal \npathology such as ileus, extrinsic compression. Abdominal exam \nwas benign. Symptoms of nausea/vomiting resolved early in \ncourse, however she was severely anorexic and was not taking any \nPOs. She was treated prn with Reglan, Compazine, Zofran however \nthese did not help with appetite. Nutrition consult was \nconsulted and followed the patient. By the time of transfer to \nthe oncology service and subsequent discharge, the patient was \ntolerating PO well.\n\n# A. flutter with RVR: Pt had history of SVT vs AVNRT vs A. \nflutter with RVR. Pt noted to have SVT on ___ and showed A. \nflutter with RVR after receiving Adenosine x 2. Patient was \nnoted to be hypotensive, likely rate related. Patient received \nIVF, since she was volume depleted ___ N/V/D. Given volume \ndepletion, her home doses of PO metoprolol and diltiazem had \nbeen held, and were restarted in setting of RVR. Atrial flutter \nremained refractory to PO meds. Patient was treated with \ndiltiazem drip, and amiodarone IV bolus and drip, with no \nimprovement in rate. Patient was DC cardioverted with return of \nsinus tachycardia. Pt was continued on PO amiodarone to maintain \nsinus rhythm. Cause of sinus tachycardia was unclear, patient \nwas afebrile, not in pain, and not anxious. LENIs were negative \nfor DVT and patient had IVC filter in place. CTA was not done \ngiven contrast allergy, and patient was already on therapeutic \nLovenox. It remained possible that tachycardia was due to spread \nof underlying malignancy as evidenced on chest CT. After she \nwas loaded on amiodarone, she was continued on a once daily \nregimen of PO amiodarone. She was discharged with instructions \nto arrange cardiology follow-up. By the time of discharge, the \npatient's tachycardia was improving.\n\n# Panhypopituitarism: Patient was noted to have low random \ncortisol. She is on Ipilimumab, which can cause panhypopit. TSH \nand free T4 were also low. PRL was borderline low. Endocrine was \nconsulted, and recommended treating empirically for adrenal \ninsufficiency. Tests will need to be repeated when patient is \noff pain medications, since these can also suppress the HPA \naxis. The patient was placed on oral prednisone with plans to \ntaper after discharge. She was also started on levothyroxine. \nAt the time of discharge, the patient was given instructions to \nfollow-up at the ___ for teaching about home glucose \nmonitoring. She was also given instructions to follow-up with \nendocrinology for further work-up of her questionable \npanhypopituitarism.\n\n# Metastatic Melanoma: Pt had known mets to the lung and is \ncurrently being followed by Dr. ___. She is currently on \nIpilimumab as part of the compassionate trial for Monotherapy in \nSubjects with Unresectable Stage III or IV Melanoma. The ICU \nteam communicated with Dr. ___. Patient underwent chest CT \nto evaluate disease progression, which did show increased size \nof large right mediastinal and hilar masses, with increased mass \neffect on the trachea, and worsening obstruction of the right \nmiddle lobe bronchus, and segmental right lower lobe bronchi. \nPatient may be candidate for new study drug once outpatient. \n\n# SIADH: Patient had normal serum sodium on admission, however \npatient was volume depleted from N/V/D x 2 weeks. Upon \nrehydration, Na decreased. Urine studies were consistent with \nSIADH, and sodium corrected with 1.5L fluid restriction. SIADH \nis likely due to metastatic lung disease.\n\n# Sinusitis: Pt was started on Ceftriaxone for tx of acute \nSinusitis that was thought to be related to her admission HA. On \nreview of CT scan no signs of sinusitis and CTX was D/Ced. \nHowever, patient continued to have mild headaches, sinus \npressure and leukocytosis that began rising after abx stopped. \nPatient was treated with 5 day course of levaquin.\n\n# 02 requirement/wheezing: Patient had wheezing on exam and new \n02 requirement noted after atrial flutter with RVR, likely due \nto pulmonary edema and worsened with IVF hydration in an attempt \nto control tachycardia. Patient improved with diuresis. \n\n# h.o.PE: Pt has history of P. Embolism even on Lovenox, has IVC \nfilter. Pt was previously on Coumadin for her A. fib however \nthis appears to have been discontinued after her episodes of \nhemoptysis. Given patient's weight, her home Lovenox dose was \ninadequate, and she was increased to 150 mg BID. LENIs were \nnegative for PE as above.\n\n# Transaminitis: Pt noted to some mild transaminitis on \nadmission, with ALT trending down 81->71, AST increased from \n38->50. Alk Phose elevated in 110s. In the past pt has been \nnoted to have high Alk Phos, pt is s/p CCY, abd not tender on \nexam. Transaminitis may be med related, ie Ceftriaxone."}}
|
{'final_diagnoses': ['Hypopituitarism', 'Metastatic Melanoma'], 'procedures': ['DC Cardioversion'], 'visit_summary': "___ y.o. Female with h.o. metastatic Melanoma to lungs, h.o. DVT \non Lovenox, presents with N/V/D and developed atrial flutter \nwith RVR. \n\n# N/V: Pt endorsed nausea over the past 2 weeks which lead to \nher admission as well as emesis x 3 days. Pt also endorses 3 \ndays of diarrhea, which resolved. Most likely dx is viral \ngastroenteritis. Head CT was negative for any masses. CT \nabd/pelvis was negative for any signs of intra-abdominal \npathology such as ileus, extrinsic compression. Abdominal exam \nwas benign. Symptoms of nausea/vomiting resolved early in \ncourse, however she was severely anorexic and was not taking any \nPOs. She was treated prn with Reglan, Compazine, Zofran however \nthese did not help with appetite. Nutrition consult was \nconsulted and followed the patient. By the time of transfer to \nthe oncology service and subsequent discharge, the patient was \ntolerating PO well.\n\n# A. flutter with RVR: Pt had history of SVT vs AVNRT vs A. \nflutter with RVR. Pt noted to have SVT on ___ and showed A. \nflutter with RVR after receiving Adenosine x 2. Patient was \nnoted to be hypotensive, likely rate related. Patient received \nIVF, since she was volume depleted ___ N/V/D. Given volume \ndepletion, her home doses of PO metoprolol and diltiazem had \nbeen held, and were restarted in setting of RVR. Atrial flutter \nremained refractory to PO meds. Patient was treated with \ndiltiazem drip, and amiodarone IV bolus and drip, with no \nimprovement in rate. Patient was DC cardioverted with return of \nsinus tachycardia. Pt was continued on PO amiodarone to maintain \nsinus rhythm. Cause of sinus tachycardia was unclear, patient \nwas afebrile, not in pain, and not anxious. LENIs were negative \nfor DVT and patient had IVC filter in place. CTA was not done \ngiven contrast allergy, and patient was already on therapeutic \nLovenox. It remained possible that tachycardia was due to spread \nof underlying malignancy as evidenced on chest CT. After she \nwas loaded on amiodarone, she was continued on a once daily \nregimen of PO amiodarone. She was discharged with instructions \nto arrange cardiology follow-up. By the time of discharge, the \npatient's tachycardia was improving.\n\n# Panhypopituitarism: Patient was noted to have low random \ncortisol. She is on Ipilimumab, which can cause panhypopit. TSH \nand free T4 were also low. PRL was borderline low. Endocrine was \nconsulted, and recommended treating empirically for adrenal \ninsufficiency. Tests will need to be repeated when patient is \noff pain medications, since these can also suppress the HPA \naxis. The patient was placed on oral prednisone with plans to \ntaper after discharge. She was also started on levothyroxine. \nAt the time of discharge, the patient was given instructions to \nfollow-up at the ___ for teaching about home glucose \nmonitoring. She was also given instructions to follow-up with \nendocrinology for further work-up of her questionable \npanhypopituitarism.\n\n# Metastatic Melanoma: Pt had known mets to the lung and is \ncurrently being followed by Dr. ___. She is currently on \nIpilimumab as part of the compassionate trial for Monotherapy in \nSubjects with Unresectable Stage III or IV Melanoma. The ICU \nteam communicated with Dr. ___. Patient underwent chest CT \nto evaluate disease progression, which did show increased size \nof large right mediastinal and hilar masses, with increased mass \neffect on the trachea, and worsening obstruction of the right \nmiddle lobe bronchus, and segmental right lower lobe bronchi. \nPatient may be candidate for new study drug once outpatient. \n\n# SIADH: Patient had normal serum sodium on admission, however \npatient was volume depleted from N/V/D x 2 weeks. Upon \nrehydration, Na decreased. Urine studies were consistent with \nSIADH, and sodium corrected with 1.5L fluid restriction. SIADH \nis likely due to metastatic lung disease.\n\n# Sinusitis: Pt was started on Ceftriaxone for tx of acute \nSinusitis that was thought to be related to her admission HA. On \nreview of CT scan no signs of sinusitis and CTX was D/Ced. \nHowever, patient continued to have mild headaches, sinus \npressure and leukocytosis that began rising after abx stopped. \nPatient was treated with 5 day course of levaquin.\n\n# 02 requirement/wheezing: Patient had wheezing on exam and new \n02 requirement noted after atrial flutter with RVR, likely due \nto pulmonary edema and worsened with IVF hydration in an attempt \nto control tachycardia. Patient improved with diuresis. \n\n# h.o.PE: Pt has history of P. Embolism even on Lovenox, has IVC \nfilter. Pt was previously on Coumadin for her A. fib however \nthis appears to have been discontinued after her episodes of \nhemoptysis. Given patient's weight, her home Lovenox dose was \ninadequate, and she was increased to 150 mg BID. LENIs were \nnegative for PE as above.\n\n# Transaminitis: Pt noted to some mild transaminitis on \nadmission, with ALT trending down 81->71, AST increased from \n38->50. Alk Phose elevated in 110s. In the past pt has been \nnoted to have high Alk Phos, pt is s/p CCY, abd not tender on \nexam. Transaminitis may be med related, ie Ceftriaxone.", 'medications_prescribed': ['1. Prednisone 10 mg Tablet Sig: As directed Tablet PO once a \nday: Take 4 tabs daily starting on ___, then decrease to 3 tabs \ndaily starting ___.\nDisp:*90 Tablet(s)* Refills:*0*', '2. Mirtazapine 30 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime). ', '3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '4. K-Phos Original 500 mg Tablet, Soluble Sig: Two (2) Tablet, \nSoluble PO twice a day. ', '5. Reglan 10 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for nausea. ', '6. Vicodin ___ mg Tablet Sig: One (1) Tablet PO every ___ \nhours as needed for pain. ', '7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO once a \nday.\nDisp:*30 Tablet(s)* Refills:*2*', '8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', "9. Enoxaparin 150 mg/mL Syringe Sig: One (1) 150 mg injection \nSubcutaneous Q12HRS ().\nDisp:*1 month's supply* Refills:*2*", '10. Glucometer\nPatient needs a glucometer. She should record her fasting blood \nsugar in the morning and her blood sugar 2 hours after each \nmeal. She should bring these glucose values to her ___ \n___ appointment on ___.']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'M', 'symptoms': 'abdominal pain/distension', 'medical_history': ['Alcoholic Liver Disease (diagnosed ___', 'Tuberculous Peritonitis (diagnosed ___'], 'family_history': 'Mother HL, HTN\nFather DM\nOne sister w/liver disease, etiology unknown', 'present_illness': "___ w/PMHx EtOH cirrhosis who was admitted to ___ from ___ to \n___ for abdominal discomfort & found to have peritoneal TB, now \npresents w/abdominal pain ongoing since ___ discharge, \nincreasing jaundice, and TB-med noncompliance. \n\nPt unable to provide much medical history to the ED or to ___ \nmedical staff. Does report ongoing diffuse abdominal pain, \nbloating and poor appetitite since going home from ___ last \nweek. Unsure why he was admitted to ___ and doesn't think they \nhelping him. He was discharged with some medications he can't \nremember (later found to be INH, ethambutol, moxifloxacin per \n___ records) which he took for ___ days, then stopped taking \nthem 4 days ago because a family member who works in ___ \nfelt he didn't need them because he doesn't have TB. There was \nconcern at home that the meds might be worsening his jaundice. \nDenies jaundice before the past month. Unaware of liver disease \npreviously, unaware of cause of liver disease at this time. Had \nnot previously seen a PCP. Stopped drinking alcohol completely \nat time of ___ admission, but previously drank ___ beers/day \nfor at least ___ years and was binging immediately prior to that \nadmission.", 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'NOON', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'NOON', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.45', 'valuenum': 3.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53.5', 'valuenum': 53.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Borderline Positive - C/W Titer of roughly 10 mIU/mL.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'POS*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'POS*. First-time positive HCV Ab will automatically reflex HCV viral load.. See results in Chemistry section..'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.558', 'valuenum': 0.558, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.36', 'valuenum': 10.36, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.006', 'valuenum': 0.006, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '61.34', 'valuenum': 61.34, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 44.8, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 8.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Measured by ___.'}, {'value': '___', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.6', 'valuenum': 51.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.5, 'valueuom': 'log10 IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '51', 'valuenum': 51.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '159919', 'valuenum': 159919.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '453', 'valuenum': 453.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'log10 IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.1', 'valuenum': 51.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.8', 'valuenum': 50.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '36', 'valuenum': 36.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51.8', 'valuenum': 51.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.3', 'valuenum': 52.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.1', 'valuenum': 52.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.6', 'valuenum': 52.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS T 98.1 HR 114 BP 105/55 RR 95%/RA \nGEN: thin, fatigued, jaundiced young man lying in bed NAD, \nspeaks softly with brevity\nHEENT: NCAT sclera icteric, MMM, oropharynx clear, EOMI, PERRL \nNeck: supple, JVP not elevated, no LAD \nCV: RRR, normal S1/S2, no mrg\nLungs: clear no r/r/w\nABD: soft, distended, diffusely tender to focal palpation \nthroughout abdominal. shifting dullness without bulging flanks. \nliver edge nonpalpable, no abdominal bruits. dry blood-soaked \ndressing over umbilicus removed, horizontal 2 cm ___ \nlaparotomy scar visible, not healed but nonerythematous, no \nexudate or active bleeding visualized \nExt: WWP, 2+ pulses, trace edema \nNeuro: CNII-XII intact, ___ strength all extremities, gait \ndeferred, no asterixis\n.\nDISCHARGE PHYSICAL EXAM:\nGEN: thin, jaundice, in no distress \nHEENT:, +scleral and subungual icterus, OP otherwise clear, EOMI \nNECK: supple, JVP not elevated, no LAD \nLUNGS: Decreased breath sounds at bases bilaterally \nCV: Tachycardic, regular rhythm, normal S1/S2, no MRG \nABD: distended but still soft, normoactive bowel sounds. \nDullness to percussion at flanks, + horizontal 2 cm \n___ laparotomy scar visible, no exudate or active \nbleeding visualized \nGU: no foley \nEXTR: WWP, 2+ pulses, 3+ ___ edema b/l up to ___ thigh \nNEURO: CNII-XII intact, ___ strength all extremities, gait \ndeferred, no asterixis \nSKIN- non palpable elongated red rash following a blood vessel \nappearance', 'diagnoses': [{'icd_code': 'C220', 'desc': 'Liver cell carcinoma'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'E440', 'desc': 'Moderate protein-calorie malnutrition'}, {'icd_code': 'K766', 'desc': 'Portal hypertension'}, {'icd_code': 'K7031', 'desc': 'Alcoholic cirrhosis of liver with ascites'}, {'icd_code': 'B1920', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'D6489', 'desc': 'Other specified anemias'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'K429', 'desc': 'Umbilical hernia without obstruction or gangrene'}, {'icd_code': 'Z6828', 'desc': 'Body mass index [BMI] 28.0-28.9, adult'}], 'summary': 'ADMISSION LABS:\n___ 11:50AM BLOOD WBC-23.5* RBC-3.06* Hgb-10.1* Hct-30.6* \nMCV-100* MCH-33.0* MCHC-33.0 RDW-15.8* Plt ___\n___ 11:50AM BLOOD Neuts-86* Bands-0 Lymphs-2* Monos-11 \nEos-0 Baso-0 ___ Myelos-1*\n___ 11:50AM BLOOD ___ PTT-46.9* ___\n___ 11:50AM BLOOD Glucose-85 UreaN-51* Creat-2.5* Na-122* \nK-6.1* Cl-89* HCO3-21* AnGap-18\n___ 11:50AM BLOOD ALT-32 AST-69* AlkPhos-139* TotBili-13.1*\n___ 11:50AM BLOOD Lipase-76*\n___ 11:50AM BLOOD Albumin-2.5* Calcium-7.7* Phos-6.5* \nMg-2.6\n___ 12:08PM BLOOD Lactate-2.2*\n___ 06:10PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n.\nURINALYSIS\n___ 01:00PM URINE Color-DkAmb Appear-Hazy Sp ___\n___ 01:00PM URINE Blood-NEG Nitrite-NEG Protein-TR \nGlucose-NEG Ketone-NEG Bilirub-MOD Urobiln-2* pH-5.0 Leuks-NEG\n___ 01:00PM URINE RBC-1 WBC-0 Bacteri-NONE Yeast-NONE \nEpi-<1 TransE-<1\n___ 01:00PM URINE CastHy-10*\n___ 01:00PM URINE Hours-RANDOM Creat-137 Na-<10 K-57 Cl-<10\n___ 06:00PM URINE Osmolal-400\n.\nPARACENTESIS\n___ 12:29PM ASCITES WBC-400* ___ Polys-29* \nLymphs-36* ___ Macroph-35*\n___ 12:29PM ASCITES TotPro-3.0 Glucose-69 Albumin-1.2\n___ 04:30PM ASCITES WBC-1500* ___ Polys-57* \n___ Monos-42* Eos-1*\n___ 04:30PM ASCITES TotPro-4.5 Glucose-4 LD(LDH)-1581 \nAlbumin-2.0\n.\nDISCHARGE LABS:\n___ 05:50AM BLOOD WBC-13.9* RBC-2.19* Hgb-7.1* Hct-22.7* \nMCV-104* MCH-32.7* MCHC-31.5 RDW-20.1* Plt ___\n___ 05:50AM BLOOD ___\n___ 05:50AM BLOOD Glucose-90 UreaN-67* Creat-1.5* Na-139 \nK-4.3 Cl-101 HCO3-23 AnGap-19\n___ 05:50AM BLOOD ALT-24 AST-78* AlkPhos-96 TotBili-7.0*\n___ 07:50AM BLOOD Calcium-9.1 Phos-3.7 Mg-1.9\n___ 10:41PM BLOOD Hapto-107\n___ 06:56AM URINE Color-Yellow Appear-Clear Sp ___\n___ 06:56AM URINE Blood-SM Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG\n___ 06:56AM URINE RBC-6* WBC-6* Bacteri-NONE Yeast-NONE \nEpi-0\n___ 03:49PM URINE CastHy-30*\n\nMICRO\nGRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n FLUID CULTURE (Final ___: NO GROWTH. \n\n ANAEROBIC CULTURE (Final ___: NO GROWTH.\nURINE CULTURE (Final ___: \n ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML..\n Cefazolin interpretative criteria are based on a dosage \nregimen of\n 2g every 8h. \n Piperacillin/tazobactam sensitivity testing available \non request. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n ESCHERICHIA COLI\n | \nAMPICILLIN------------ =>32 R\nAMPICILLIN/SULBACTAM-- 16 I\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN--------- =>4 R\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\nMRSA SCREEN (Final ___: No MRSA isolated.\n**FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH\n**FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n___ 8:30 am SPUTUM Source: Induced. \n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\nRAPID PLASMA REAGIN TEST (Final ___: \n NONREACTIVE. \n **FINAL REPORT ___\n\n CMV IgG ANTIBODY (Final ___: \n POSITIVE FOR CMV IgG ANTIBODY BY EIA. \n 56 AU/ML. \n Reference Range: Negative < 4 AU/ml, Positive >= 6 AU/ml. \n\n\n CMV IgM ANTIBODY (Final ___: \n NEGATIVE FOR CMV IgM ANTIBODY BY EIA. \n INTERPRETATION: INFECTION AT UNDETERMINED TIME. \n\n___ 6:41 pm SPUTUM Source: Induced. \n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n\nURINE CULTURE (Final ___: \n YEAST. 10,000-100,000 ORGANISMS/ML..\n\n___ 2:10 pm STOOL CONSISTENCY: SOFT Source: Stool. \n\n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n Negative for toxigenic C. difficile by the Illumigene DNA\n amplification assay. \n (Reference Range-Negative). \n\n___ 12:40 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\n___ 4:30 pm PERITONEAL FLUID PERITONEAL FLUID. \n\n GRAM STAIN (Final ___: \n 2+ ___ per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n FLUID CULTURE (Final ___: NO GROWTH. \n\n ANAEROBIC CULTURE (Final ___: NO GROWTH. \n\n FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. \n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n\n___ 4:30 pm FLUID RECEIVED IN BLOOD CULTURE BOTTLES\n PERITONEAL FLUID. \n\n BLOOD/FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. \n\n BLOOD/AFB CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n___ 4:45 pm BLOOD CULTURE 2 OF 2. \n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\nURINE CULTURE (Final ___: NO GROWTH. \n\nURINE CULTURE (Final ___: \n YEAST. 10,000-100,000 ORGANISMS/ML..\n\n.\nIMAGING\n___ RUQ US\nFINDINGS: The liver is heterogeneous and nodular consistent with \ncirrhosis. \nNo focal liver lesions are identified. The portal vein is patent \nwith \nreversal of flow, suggesting portal hypertension. There is trace \nperihepatic ascites. The gallbladder is nondistended. The wall \nis mildly thickened, likely due to abdominal ascites. There is \nsludge within the gallbladder. \nThere is no evidence of cholecystitis. The pancreas is not well \nevaluated due to overlying bowel gas. The spleen is borderline \nenlarged and measures 12.4 cm. \nThere are small bilateral pleural effusions. \nThe kidneys are unremarkable without renal stones, masses, or \nhydronephrosis. \nThe left kidney measures 12.7 cm. The right kidney measures 13.2 \ncm. \nThere is a large amount of hypoechoic complex fluid within the \nmid abdomen \nextending into the bilateral lower quadrants, more so on the \nleft than the \nright. There is also complex hypoechoic fluid in ___ \npouch. There is no increased vascularity. These findings are \nmost consistent with hemorrhagic or infected ascites. \nIMPRESSION: \n1. Cirrhotic liver without focal masses. \n2. Patent portal vein with reversal of flow, suggesting portal \nhypertension. \n3. Complex fluid within the abdomen may be hemorrhagic or \ninfected ascites. \n4. Sludge within the gallbladder, but no evidence of acute \ncholecystitis. \n.\n___ CXR\nFINDINGS: Frontal and lateral views of the chest were obtained. \nThere are \nrelatively low lung volumes. Bibasilar opacities are seen which \nin \ncombination with recent ultrasound are likely due to bilateral \npleural \neffusions with overlying atelectasis, underlying consolidation \nnot excluded. There is no pneumothorax. The cardiac silhouette \nis not enlarged. \nMediastinum is unremarkable. \nIMPRESSION: Bilateral pleural effusions with overlying \natelectasis; \nunderlying consolidation not excluded. \n.\n___ Abdominal U/S Ascites search: Limited four quadrant \nultrasound was performed to assess for ascites. Limited \nultrasound demonstrates the presence of loculated ascites \nbilaterally. There was no large pocket of fluid visualized \nwithin all four quadrants to target for paracentesis. \nIMPRESSION: Extensive loculated ascites with no large pocket of \nfluid identified to target for paracentesis. Findings were \ndiscussed with ICU team at the time of procedure in person. \n.\n___ CXR (portable): There is a Dobbhoff tube within the \nstomach. There are bilateral pleural effusions with bibasilar \nopacities which may represent atelectasis. The upper lung zones \nare clear. Mediastinal silhouette is stable. \nIMPRESSION: Dobbhoff tube within the stomach. Bilateral pleural \neffusions and bibasilar opacities, which may represent \natelectasis. Cannot exclude underlying pneumonia. \n\nCHEST (PORTABLE AP) Study Date of ___ 2:24 ___ \nFINDINGS: The Dobbhoff tube is in the mid stomach. Bilateral \npleural \neffusions and volume loss/consolidation in the lower lobes are \nagain \nvisualized. \n \nABDOMEN U.S. (COMPLETE STUDY) Study Date of ___ 11:29 AM \nIMPRESSION: \n1. Patent main portal vein with reversal of flow, consistent \nwith cirrhosis. \n2. Extensively loculated ascites is not amenable for \ntherapeutic \nparacentesis. \n3. Small right pleural effusion. \n \nCHEST (PORTABLE AP) Study Date of ___ 5:17 ___ \nFINDINGS: The Dobbhoff tip projects over the right upper \nquadrant, and is \nlikely located in the distal stomach or proximal duodenum. \n \nKnown bilateral pleural effusions from the previous radiograph. \nUnchanged \nsubsequent bibasilar consolidations. No evidence of \ncomplications, unchanged \nsize of the cardiac silhouette. \n \nPathology Examination \n\nName ___ Age Sex Pathology # ___ MRN# \n___ ___ ___ Male ___ \nCONSULT \nReport to: ___. ___ \nGross ___ by: ___. ___ \n\n \nSPECIMEN SUBMITTED: Slides referred for consultation.\n\nProcedure date Tissue received Report Date Diagnosed \nby \n___ ___. ___ \n************This report contains an addendum***********\n\nDIAGNOSIS: \n\n \nConsult slides labeled ___-___, dated ___, ___ \n___:\n\n \nI. Liver, FNA (7 slides sublabeled A1-7):\n\n1. Benign hepatocytes and bile ducts seen on direct smears.\n\n \n2. Numerous neutrophils seen on liquid based preparations. See \nnote #1.\n\nII. Liver, targeted needle core biopsy (2 slides sublabeled \nB1-1 and ___:\n\n1. Established cirrhosis (Stage 4 fibrosis). See note # 2.\n\n \n2. Mild predominantly macrovesicular steatosis with rare \nballooning degeneration and abundant intracytoplasmic hyalin \nidentified. \n\n \n3. Moderate septal, mild periseptal and lobular mixed \ninflammation consisting of lymphocytes, neutrophils, and rare \nplasma cells.\n\nNote #1: The neutrophils seen on the liquid based preparation \nare not seen on the duct smears. This can be attributed to \nsampling. If the neutrophils are representative of the lesion, \nthen an inflammatory/abscess process should be considered. \nRadiologic and clinical correlation, as to the site of sampling, \nis recommended. The case findings were discussed with Dr. ___. \n___ by Dr. ___ on ___. \n\nNote #2: The findings are that of an end stage cirrhotic liver \nwith features consistent with toxic/ metabolic injury. There is \nno explanation for a mass lesion in this biopsy. No granulomas \nare seen.\n\nADDENDUM: On ___, received from ___ \n___, ___ are three (3) \nunstained slides labeled "___" and all sub labeled B 1 from \nprocedure date ___. The patient\'s name on the \ncorresponding report is ___." \n\nAddendum added by: ___. ___ \nDate: ___\n\nClinical: Liver mass; Question cholangiocarcinoma vs abscess \nvs TB. \nGross: Received from ___ are two (2) H&E stained slides labeled \n"___ ___ and sub labeled B ___ and B ___ from \nprocedure date ___. Also included are three (3) cytology \nslides sub labeled A-2 Liver FNAB, A-3 Liver FNAB and A-7 Liver \nFNAB. Also included are four (4) smears sub labeled A-1, A-4, \nA-5 and A-6. The patient\'s name on the corresponding report is \n___." \n\nCHEST (PORTABLE AP) Study Date of ___ 9:03 ___ \nThe NG tube tip terminates in the stomach. Bilateral large \npleural effusions \nappear to be increased since the prior study. They obscure the \ncardiac border \nthat the assessment of the cardiac size cannot be done. Bibasal \nareas of \natelectasis are unchanged. \n \nCHEST (PORTABLE AP) Study Date of ___ 4:27 ___ \nFINDINGS: Scattered radiation related to the size of the \npatient greatly \nobscures detail. However, the intestinal tube does appear to \nextend to the \nmid body of the stomach. \n \n \n****************\n___ RECORDS\n___ labs\nAdmission LFTs (___) ALT 52 AST 123 AlkP 276 tbili 5.8 dbili \n2.4\nDischarge LFTs (___) ALT 29 AST 78 Alkp 173 tbili 10.8 dbili \n6.6\nHIV negative\nHepatitis A Ab positive\nHep B serologies/VL all negative \nHep C Ab negative \nQuantiferon Gold positive\nT-spot TB positive \nAFP ___\nFe 49 TIBC ___ Ferritin 826 B12 1815 Folate 7.6\nTSH ___ fT4 1.2\naldosterone 97 renin 37\ncortisol 23.4 (5:30 pm)\nCBC ___: WBC 18.4 HCT 31.4 Plt 399\n___: Na 124 K 4.3 Cl 90 Co2 24.2 BUN 22 Cr 0.9 Glu 92\n\n___ micro\n___ peritoneal fluid - culture negative for mycobacteria \nafter 15 days. No AFB observed. Abundant mononuclear cells.\n\n___ surgical specimen (unspecified - peritoneal and omental \nsamples sent) - bacterial cx no growth, AFB smear negative, \nmycobacterial culture - negative after 5 days, fungal prep - no \nfungi seen, fungal culture - negative after 5 days\n\n___ Ascites Fluid - culture no growth, AFB prelim negative, \nmyobacterial culture negative after 13 days.\n\n___ imaging\n___ CT CHEST\n2 upper lobe pulmonary nodules 4-5 mm indeterminate etiology.\n\n___ MRI LIVER\n1. 3.6x2.8 cm well-circumscribed lesions within segment 5 of the \nliver has no engancement material phase and subsequent \nhyperenhancement on delayed images, with the appearance of a \nfocal mass rather than focal infection. This lesion does not \nhave an appearance typical for metastatic carcinoma. Enhancement \npattern raises the suspicion for cholangiocarcinoma, although \nless likely may represent a secondary primary of unknown \netiology. Consider further evaluation with image guided biopsy \nof the focal lesion.\n2. Heterogeneous perfusion of the liver predominant central \nportion around the oprta hepatis likely perfusion anomaly due to \nunderlying cirrhosis.\n3. Nodular hepatic contour, suggesting cirrhosis.\n4. Omental and peritoneal increased vascularity and hyperemia. \nThin peritoneal enhancement, unchanged and likely relating to \nperitonitis.\n\n___ CT ABD/PELVIS WITH CONTRAST\n1. Enhancing peritoneal lining and mesenteric stranging \nsuggestive of peritonitis. Differential considerations include \ntuberculous peritonitis.\n2. Cirrhotic liver morphology w/ascites, multiple varices, \nmesenteric congestion.\n3. 3.7 cm hypodense lesion in segment 4 of the liver, \nindeterminate. Findings could represent malignant or infectious \netiologies.\n\n___ RUQ US\nAscites and Cirrhosis. Gallbladder sludge.\n\n___ PATHOLOGY\n___ peritoneum biopsy\nDiffuse granulomatous inflammation. Multinucleated giant cells \nand central degeneration are noted. No necrosis is observed. The \nfindings are consistent with the clinical diagnosis of \nperitoneal tuberculosis. A special stain for AFB is pending.\n\n___ Omentum biopsy\n(result identical to peritoneum biopsy): Diffuse granulomatous \ninflammation. Multinucleated giant cells and central \ndegeneration are noted. No necrosis is observed. The findings \nare consistent with the clinical diagnosis of peritoneal \ntuberculosis. A special stain for AFB is pending.\n\n___ Stomach biopsy\nGastric transition zone mucose with chronic inactive gastritis \nand multifocal intestinal metaplasia. Immunostain for H pylori \nis negative.\n\n___ Liver FNA biopsy\nNondiagnostic specimen. Benign hepatocytes and ductal cells. \nAcute inflammatory cells on the Surepath slide only. Cirrhotic \nliver. \n\n___ ASCITES CYTOLOGY\nNo malignant cells identified.\n\nEGD ___\nGrade B esophagitis. \nGrade 1 varices lower esiphagus, no stigmata of bleeding or red \n___ sign. No banding performed. Diffuse moderate gastric \ninflammation/erythema c/w chronic gastritis. Multiple very small \ncelean-based superficial ulders (biopsied). Normal duodenum. \nH pylori samples sent (pending)\nMr. ___ is a ___ year old ___ gentleman with recent \ndiagnoses of alcoholic hepatitis and TB peritonitis, \nhospitalized at ___ ___ for these problems, admitted with \nincreasing abdominal pain and distention after not taking his \nmedications for several days, now being treated for TB \nperitonitis, with MICU course c/b ___ concerning for HRS and \ndecompensated liver cirrhosis.\n.\n.\nACTIVE ISSUES:\n# TB PERITONITIS:\nDiagnosed at ___ a few weeks prior to this admission, when he \nwas admitted for abdominal discomfort. Diagnosis initially \nsuspected due to pt\'s when CT scan was suggestive of peritoneal \nTB, TB-spot and quantiferon gold positive and \nperitoneal/omental biopsies demonstrated granulomatous \ninflammation. Being from ___ is his primary risk factor; no \nIVDU or prison/homeless exposures. CT chest at ___ showed "upper \nlobe pulmonary nodules" not further evaluated. Sputum AFBs were \nsent x 3 and were negative for TB. ID was consulted and felt \nthat triple therapy with INH w/B12 supplementation, moxifloxacin \nand ethambutol as prescribed by ___ was appropriate. Attempted \nto obtain ___ paracentesis, but ultrasound showed loculated fluid \ncollections not amenable to drainage. We discussed his treatment \nplan with Department of health who requested he stay on \ntreatment for TB until his cultures from ___ return negative \nwhich may take many months. He remained on the three antibiotics \nmentioned above for the duration of his hospital stay. Upon \ndischarge from ___ he should follow up with Dr. ___ \n___ - ___ (cell phone), ___ at \n___ infectious disease.\n\n.\n# ETOH CIRRHOSIS\nPt w/jaundice elevated DF on admission. Disease likely \nlongstanding as pt has cirrhosis/nodular liver demonstrated on \nall imaging studies at ___ (MRI,CT,US). Not a candidate for \nsteroids. Na 124, consistent w/recent labs at ___. Hct stable, \n~30. Hepatology was consulted and recommended albumin for fluid \nresuscitation. Patient subsequently had BRBPR with \napproximately 100cc of gross blood in stool. Started on \noctreotide and PPI drip, octreotide was stopped after one day \nand was transitioned to PPI BID. Patient had Dobbhoff placed and \nwas started on TFs as per nutrition recommendations. Large \nvolume paracentesis by ___ was not able to be obtained as above. \nHe also was started on Lactulose daily to achieve ___ bowel \nmovements per day. He showed no signs of hepatic encephalopathy \nduring his course. Tube feeds were continued for 2 weeks and his \nliver function significantly improved from admission.\n\n# Anemia \nPt reported small volume BRB in toilet bowl on day PTA. EGD last \nweek showed only 1 cord grade 1 varices. No prior hx GIB \nsymptoms. Pt could have rectal varices, or hemorrhoids. Had \nrepeat gross blood in stool on HD 2 and was started on \noctreotide and pantoprazole gtt. Also received vitamin K and 4 \nof FFP. After transfer out of the MICU, patient continued to \nexperience Guaiac positive stool, with occasional small amount \nof bright red blood at the end of his bowel movement. It was \ndetermined that he had hemorrhoids. Per GI recommendations, no \nendoscopy was performed. His HCT trended down slowly over the \ncourse of his hospitalization which most likely was attributed \nto continued phlebotomy more than GI blood loss. He was \ntransfused on two occasions for Hct < 21. \n\n#Acute Kidney Injury\nPt Cr up to 2.5 on admission. This was believed to be due to \nHRS. Nephrology was consulted and recommended fluid \nresuscitation with albumin and initiation of midodrine and \noctreotide. He completed a two week course of this regimen and \nhis creatine slowly trended down to 1.3-1.5. \n\n#Spontaneous Bacterial Peritonitis- During this hospitalization \nthe pt was complaining of increasing abdominal pain. A \ndiagnostic paracentesis was obtained and was concerning for SBP. \nHe was started on ceftriaxone and metronidazole for therapy for \nwhich he completed a 7 day course. His abdominal pain resolved \nwith this regimen.\n\n# Abdominal Cellulitis- During this hospitalization the pt \ndeveloped a cellulitic rash on his abdominal wall that was \nspreading outside outlined boarders. Vancomycin was added to his \ndaily antibiotic regimen as well which resolved the cellulitis. \nHe completed a 7 day course of Vancomycin. \n\n#Hypervolemia- Pt developed significant ___ edema during this \nhospitalization. This was related to his underlying liver \ncirrhosis and initial discontinuation of diuretics due to ___. \nOnce his kidney failure was improving with treatment for HRS, \ntorsemide was initiated and the pt\'s urine out and kidney \nfunction improved further. He was encouraged to continue to \nelevate his legs while seated and to limit is salt intake to 2g \ndaily and his water intake to 1.5L daily. After discontinuation \nof tube feedings his ___ edema began to slowly improve as well.\n\n# HYPERKALEMIA\nPt dehydrated with hx poor PO intake over the past week. EKG \nwithout peaked t-waves. Received 1L fluid and Kayexalate in ED, \nalbumin resuscitation. K down with albumin and was 4.0 on call \nout from MICU. On the floor his potassium remained in the normal \nrange.\n\n# HYPONATREMIA\nOften corresponds w/liver failure. Stable at 124 initially per \nOSH records. Improved with albumin resuscitation to 130s-140s \nand remained stable in that range.\n\n# ASCITES\nParacentesis in ED not c/w SBP. Received 1 dose Ceftriaxone in \nthe ED. Therapeutic paracentesis was not obtainable due to \nsignificant loculations of the ascitic fluid. His abdominal \nascites improved with initiation of Torsemide.\n\n# Transitional:\n1. pt is discharged to ___ for further antibiotic \ntreatment\n2. F/u with Health Department case manager ___ \n___ at time of discharge for assistance with his \ndischarge plan \n3. Continue to trend his HCT daily, our transfusion goal was Hct \n< 21 \n4. Please continue to trend kidney function and INR daily'}}
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{'final_diagnoses': ['Liver Cirrhosis', 'TB Peritonitis', 'Acute on Chronic Kidney Injury'], 'procedures': ['Paracentesis'], 'visit_summary': 'Mr. ___ is a ___ year old ___ gentleman with recent \ndiagnoses of alcoholic hepatitis and TB peritonitis, \nhospitalized at ___ ___ for these problems, admitted with \nincreasing abdominal pain and distention after not taking his \nmedications for several days, now being treated for TB \nperitonitis, with MICU course c/b ___ concerning for HRS and \ndecompensated liver cirrhosis.\n.\n.\nACTIVE ISSUES:\n# TB PERITONITIS:\nDiagnosed at ___ a few weeks prior to this admission, when he \nwas admitted for abdominal discomfort. Diagnosis initially \nsuspected due to pt\'s when CT scan was suggestive of peritoneal \nTB, TB-spot and quantiferon gold positive and \nperitoneal/omental biopsies demonstrated granulomatous \ninflammation. Being from ___ is his primary risk factor; no \nIVDU or prison/homeless exposures. CT chest at ___ showed "upper \nlobe pulmonary nodules" not further evaluated. Sputum AFBs were \nsent x 3 and were negative for TB. ID was consulted and felt \nthat triple therapy with INH w/B12 supplementation, moxifloxacin \nand ethambutol as prescribed by ___ was appropriate. Attempted \nto obtain ___ paracentesis, but ultrasound showed loculated fluid \ncollections not amenable to drainage. We discussed his treatment \nplan with Department of health who requested he stay on \ntreatment for TB until his cultures from ___ return negative \nwhich may take many months. He remained on the three antibiotics \nmentioned above for the duration of his hospital stay. Upon \ndischarge from ___ he should follow up with Dr. ___ \n___ - ___ (cell phone), ___ at \n___ infectious disease.\n\n.\n# ETOH CIRRHOSIS\nPt w/jaundice elevated DF on admission. Disease likely \nlongstanding as pt has cirrhosis/nodular liver demonstrated on \nall imaging studies at ___ (MRI,CT,US). Not a candidate for \nsteroids. Na 124, consistent w/recent labs at ___. Hct stable, \n~30. Hepatology was consulted and recommended albumin for fluid \nresuscitation. Patient subsequently had BRBPR with \napproximately 100cc of gross blood in stool. Started on \noctreotide and PPI drip, octreotide was stopped after one day \nand was transitioned to PPI BID. Patient had Dobbhoff placed and \nwas started on TFs as per nutrition recommendations. Large \nvolume paracentesis by ___ was not able to be obtained as above. \nHe also was started on Lactulose daily to achieve ___ bowel \nmovements per day. He showed no signs of hepatic encephalopathy \nduring his course. Tube feeds were continued for 2 weeks and his \nliver function significantly improved from admission.\n\n# Anemia \nPt reported small volume BRB in toilet bowl on day PTA. EGD last \nweek showed only 1 cord grade 1 varices. No prior hx GIB \nsymptoms. Pt could have rectal varices, or hemorrhoids. Had \nrepeat gross blood in stool on HD 2 and was started on \noctreotide and pantoprazole gtt. Also received vitamin K and 4 \nof FFP. After transfer out of the MICU, patient continued to \nexperience Guaiac positive stool, with occasional small amount \nof bright red blood at the end of his bowel movement. It was \ndetermined that he had hemorrhoids. Per GI recommendations, no \nendoscopy was performed. His HCT trended down slowly over the \ncourse of his hospitalization which most likely was attributed \nto continued phlebotomy more than GI blood loss. He was \ntransfused on two occasions for Hct < 21. \n\n#Acute Kidney Injury\nPt Cr up to 2.5 on admission. This was believed to be due to \nHRS. Nephrology was consulted and recommended fluid \nresuscitation with albumin and initiation of midodrine and \noctreotide. He completed a two week course of this regimen and \nhis creatine slowly trended down to 1.3-1.5. \n\n#Spontaneous Bacterial Peritonitis- During this hospitalization \nthe pt was complaining of increasing abdominal pain. A \ndiagnostic paracentesis was obtained and was concerning for SBP. \nHe was started on ceftriaxone and metronidazole for therapy for \nwhich he completed a 7 day course. His abdominal pain resolved \nwith this regimen.\n\n# Abdominal Cellulitis- During this hospitalization the pt \ndeveloped a cellulitic rash on his abdominal wall that was \nspreading outside outlined boarders. Vancomycin was added to his \ndaily antibiotic regimen as well which resolved the cellulitis. \nHe completed a 7 day course of Vancomycin. \n\n#Hypervolemia- Pt developed significant ___ edema during this \nhospitalization. This was related to his underlying liver \ncirrhosis and initial discontinuation of diuretics due to ___. \nOnce his kidney failure was improving with treatment for HRS, \ntorsemide was initiated and the pt\'s urine out and kidney \nfunction improved further. He was encouraged to continue to \nelevate his legs while seated and to limit is salt intake to 2g \ndaily and his water intake to 1.5L daily. After discontinuation \nof tube feedings his ___ edema began to slowly improve as well.\n\n# HYPERKALEMIA\nPt dehydrated with hx poor PO intake over the past week. EKG \nwithout peaked t-waves. Received 1L fluid and Kayexalate in ED, \nalbumin resuscitation. K down with albumin and was 4.0 on call \nout from MICU. On the floor his potassium remained in the normal \nrange.\n\n# HYPONATREMIA\nOften corresponds w/liver failure. Stable at 124 initially per \nOSH records. Improved with albumin resuscitation to 130s-140s \nand remained stable in that range.\n\n# ASCITES\nParacentesis in ED not c/w SBP. Received 1 dose Ceftriaxone in \nthe ED. Therapeutic paracentesis was not obtainable due to \nsignificant loculations of the ascitic fluid. His abdominal \nascites improved with initiation of Torsemide.\n\n# Transitional:\n1. pt is discharged to ___ for further antibiotic \ntreatment\n2. F/u with Health Department case manager ___ \n___ at time of discharge for assistance with his \ndischarge plan \n3. Continue to trend his HCT daily, our transfusion goal was Hct \n< 21 \n4. Please continue to trend kidney function and INR daily', 'medications_prescribed': ['isoniazid ___ mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'moxifloxacin 400 mg Tablet Sig: One (1) Tablet PO daily ().', 'ethambutol 400 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily).', 'omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day.', 'folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.', 'oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours) as needed for pain.', 'lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day): to achieve ___ bowel movements per day.', 'torsemide 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 71, 'gender': 'F', 'symptoms': 's/p STEMI complicated by VF arrest', 'medical_history': ['Chronic pancreatitis', 'Alcohol abuse', 'Cocaine abuse'], 'family_history': '- Hypertension, cancer. No known history of sudden death, \narrhythmias. \n- Mother: died of lung cancer \n- Father: died of stroke, ___ \n- Sister: died of lung disease (asthma, emphysema)', 'present_illness': "___ F with unclear PMHx presenting s/p VF arrest. Per report of \nsister, patient sat up in bed complaining that she felt hot and \nvomited several times. She lost consciousness, and sister \nlowered her to floor and began CPR while 911 was called. On \narrival of EMS, patient was shocked 6 times and got 6 rounds of \nepinephrine. Rhythm was ventricular fibrillation. Patient was \ngiven 300mg amiodarone. She was intubated and had return of \nspontaneous circulation. \n. \nIn ED, ECG showed ST elevations in II, III, avF, V4-V6. A code \nSTEMI was called. Patient received asa 600mg PR, protonix and \nheparin bolus. Heparin drip, clopidogrel and integrelin were not \ngiven because of concern for GI bleed given blood per NGT. She \nwas sedated with midazolam. She was not responsive and not \nmoving, but had positive gag and cough. Labs were significant \nfor a pH of 7.04 with a lactate of 11.8, bicarb 11, and K 3.3. \nHead CT showed no acute intracranial process and CXR showed no \nacute cardiopulmonary process. Hypothermia pads were placed but \ncooling was not started as patient's temperature was 34 degrees \ncelsius. \n. \nOn arrival to CCU, VS were T35.7, HR 106, BP 116/98, RR 28, 99% \non 100% FiO2. Patient was moving fingers and toes and \nwithdrawing to pain but was not arousable. She was diaphoretic \nand overbreathing vent, and was given midazolam and fentanyl. \nHypothermia protocol was started and patient was paralyzed with \ncisatracurium. \n. \nUnable to do review of systems as patient non-responsive. Per \nsister, patient had no recent complaints of chest pain or \nshortness of breath.", 'medications': [{'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'PL', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ascorbic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pyridoxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone-Salmeterol Diskus (100/50)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 20.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '297', 'valuenum': 297.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '294', 'valuenum': 294.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '365', 'valuenum': 365.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "Admission physical exam:\nVS: T 95.5 BP 116/98 HR 106 ST RR 28 O2Sat 99% on 100% FiO2 \nGENERAL: Intubated and sedated, diaphoretic. \nHEENT: NCAT. Sclera anicteric. Pupils 3mm and equal, not \nreactive to light. +doll's eyes. ETT in place. +nasal flaring \nNECK: Supple \nCARDIAC: Difficult to auscultate due to loud breath sounds. \nTachycardic, regular, normal S1/S2, no m/r/g appreciated. \nLUNGS: Course upper airway noise with breath sounds equal in all \nlung fields anteriorly. +accessory muscle use, +nasal flaring \nABDOMEN: Soft, nontender, nondistended, +bowel sounds. RLQ \nsurgical scar. \nEXTREMITIES: WWP, no cyanosis, no edema. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+", 'diagnoses': [{'icd_code': '1623', 'desc': 'Malignant neoplasm of upper lobe, bronchus or lung'}, {'icd_code': '5121', 'desc': 'Iatrogenic pneumothorax'}, {'icd_code': '4271', 'desc': 'Paroxysmal ventricular tachycardia'}, {'icd_code': '99881', 'desc': 'Emphysema (subcutaneous) (surgical) resulting from procedure'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}], 'summary': "Admission labs:\nWBC 9.5 Hgb 19.4 Hct 36.0 Plts 292 \nNa 143 K 3.3 Cl 106 bicarb 11 BUN 6 Cr 1.0 Gluc 152 \nLactate 11.8 pH 7.04 \nTox screen: negative\n\nAdmission studies:\n- ECG: Sinus tachycardia (94bpm), ST elevations in II, III, avF, \nV4-V6. \n- CXR: No acute cardiopulmonary process \n- Head CT: No acute intracranial process \n\nPertinent labs/studies:\n- Urine tox- +benzos, -barb, -opiates, -cocaine, -amphet, \n+methadone\n- U/A (___)- RBC 91 WBC 18 bact-mod epi-2 nitrite-neg \nleuks-mod\nUrine culture- CITROBACTER FREUNDII COMPLEX. >100,000 \nORGANISMS/ML..\n \n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n CITROBACTER FREUNDII COMPLEX\n | \nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\n- Sputum culture (___)- STAPH AUREUS COAG +. MODERATE \nGROWTH. \n Staphylococcus species may develop resistance during \nprolonged\n therapy with quinolones. Therefore, isolates that are \ninitially\n susceptible may become resistant within three to four \ndays after\n initiation of therapy. Testing of repeat isolates may \nbe\n warranted. \n STENOTROPHOMONAS (XANTHOMONAS) MALTOPHILIA. SPARSE \nGROWTH. \n SENSITIVE TO CHLORAMPHENICOL AT <=8 MCG/ML. \n Intermediate TO TIMENTIN AT 32 MCG/ML . \n sensitivity testing performed by Microscan. \n ACINETOBACTER BAUMANNII COMPLEX. SPARSE GROWTH. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPH AUREUS COAG +\n | STENOTROPHOMONAS \n(XANTHOMONAS) MALTOPH\n | | \nCEFTAZIDIME----------- =>16 R\nCLINDAMYCIN-----------<=0.25 S\nERYTHROMYCIN----------<=0.25 S\nGENTAMICIN------------ <=0.5 S\nLEVOFLOXACIN----------<=0.12 S 1 S\nOXACILLIN------------- 0.5 S\nTRIMETHOPRIM/SULFA---- <=0.5 S 2 S\n\n- Blood culture (___) x2- no growth to date\n- Blood culture (___)- no gowth to date\n\n- Cardiac catheterization (___)-\n1. One vessel coronary artery disease.\n2. Severe diastolic ventricular dysfunction. Systolic function \nnot \nassessed in the cath lab.\n3. Acute anterior myocardial infarction involving very distal \nLAD, \nmanaged by medical therapy.\n\n- Transthoracic echocardiogram (___)- The left atrium is \nnormal in size. No atrial septal defect is seen by 2D or color \nDoppler. Left ventricular wall thicknesses are normal. The left \nventricular cavity size is normal. There is moderate regional \nleft ventricular systolic dysfunction with mid to distal \nLV/apical akinesis (difficult to interpret relevance of this \nunusual regionality pattern in setting of post cardiac arrest \nrescuscitation I.e. given IV epinephrine. CAD versus Takotsubo \nCM verusus myocarditis). The basal LV systolic function is \npreserved. No masses or thrombi are seen in the left ventricle. \nThere is no ventricular septal defect. Right ventricular chamber \nsize is normal. with focal hypokinesis of the apical free wall. \nThe diameters of aorta at the sinus, ascending and arch levels \nare normal. The aortic valve leaflets (3) are mildly thickened \nbut aortic stenosis is not present. Mild (1+) aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. There is no mitral valve prolapse. Mild to moderate \n(___) mitral regurgitation is seen. There is moderate pulmonary \nartery systolic hypertension. There is no pericardial effusion. \n\n\n- MRI head w/wo contrast (___)- Multiple acute infarcts \nfound bilaterally in the parietal and occipital lobes, and in \nthe cerebellar hemispheres. Likely infarcts found bilaterally in \nthe paramedian frontovertex cortex. Given the wide distribution \nof the infarcts, both supra- and infratentorial and bilateral, \nthese are likely embolic, from a central source.\nPrimary Reason for Hospitalization:\n___ yo female with PMHx presenting s/p STEMI c/b VF arrest.\n\nSummary of Hospital Course:\n# s/p VF arrest: Patient was down for approximately 20 minutes \nprior to return of spontaneous circulation. Patient was cool on \narrival, and hypothermia protocol was initiated when she arrived \non floor. She was noted to have a prolonged QT interval on EKG \nthroughout her stay, and her K+ and Mg+ were frequently repleted \nto maintain K>4.5 and Mg>2.5. She was hypotensive following \nrewarming, requiring addition of phenylephrine for pressure \nsupport in addition to milrinone. EEG showed evidence of status \nepilepticus, and she was started on keppra and propofol but \ncontinued to seize and fosphenytoin was added. An MRI of the \nhead was performed and showed small areas of infarction \nthroughout the brain. Patient was placed in a pentobarbital \ncoma for 48 hours to suppress seizure activity. She was \ntransitioned from milrinone to dopamine and eventually also \nrequired addition of levophed given her poor urine output and \nrising creatinine. With the addition of levophed she maintained \nMAP in the mid ___ and phenylephrine was successfully weaned \noff. \n.\nFollowing completion of pentobarbital therapy, she remained \nunresponsive with no apprarent brainstem reflexes. She was also \nnoted to have blown pupils on exam on HD 5. Neurology examined \nthe patient and noted that she had no sustained brainstem \nactivity 48 hours after cessation of phenobarb. On HD#7 her HR \nand blood pressure declined despite maximum dopamine and \nlevophed support. A family meeting was held regarding goals of \ncare given her poor neurologic prognosis, and the family elected \nto withdraw care. They requested a chaplain to offer a prayer \nfor the patient and her family. Her pressors and ventilation \nwere discontinued. At 13:40, she passed away with her family at \nbedside. The Medical Examiner's Office accepted the patient for \nautopsy, which the family supports.\n\n# s/p STEMI: It is still unclear why this patient suffered an \nacute STEMI. Initial EKG showed large area of myocardium \naffected. Cardiac cath on day of admission showed lesion in the \nvery distal LAD which was not intervenable. Urine tox negative \nfor cocaine. Significant smoking history. Patient was medically \nmanaged with aspirin, prasugrel, heparin gtt x 48 hrs, \nmetoprolol, and captopril. Echocardiogram performed the day of \nevent showed moderate left ventricular systolic dysfunction with \nmid to distal LV/apical akinesis.\n.\n# Fever/ Leukocytosis: Patient was noted to have temperatures to \n___ F in the setting of cooling in addition to an elevated white \nblood cell count, increased sputum and urine with a large amount \nof sediment. The patient was started on broad spectrum \nantibiotics with vancomycin and cefepime. Culure of the sputum \nSputum grew MSSA and stenotrophomonas (ceftaz-resistant, \nbactrim-sensitive), and urine culture grew citerobacter \n(pan-sensitive). Per ID recommendation patient was started on \nIV nafcillin and IV bactrim as she was unable to take PO \nmedications and could not have levoquin given her long QT. \n.\n# Diabetes Insipidus: On HD 5 patient was noted to be \nhypernatremic with a sodium level of 155. Urine osmolatlity was \nlow suggesting diabetes insipidus, likely central given her \nneurological injury. The patient was given DDAVP 2 mcg IV and \nD5W to replete free water with improvement in her hypernatremia. \nSodium remained stable for the remainder of hospitalization. \n.\n# Transaminitis: The patient was noted to have elevated LFTs on \nadmission believed to be secondary to poor organ perfusion. \nLFTs trended down during hospitalization, but did not return to \nnormal. \n.\n#Normocytic anemia: Hematocrit dropped acutely from 27 to 21.1 \novernight on HD3. There were no obvious signs of GI bleed from \nrectum or OG tube. Smear showed occasional schistocytes, not \nconvincing for active hemolysis. Patient was tranfused 2UPRBCs \non HD4, and hematocrit responded minimally. Reticulocyte count \nwas elevated, supporting appropriate bone marrow functioning."}}
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{'final_diagnoses': ['ST-elevation Myocardial infarction', 'Cardiac arrest', 'Cerebrovascular accident'], 'procedures': ['Cardiac Catheterization: ___ ___', 'Left heart catheterization', 'Right heart catheterization', 'Selective coronary angiography', 'Right ileofemoral angiography', 'Deployment of Angioseal to ___'], 'visit_summary': "Primary Reason for Hospitalization:\n___ yo female with PMHx presenting s/p STEMI c/b VF arrest.\n\nSummary of Hospital Course:\n# s/p VF arrest: Patient was down for approximately 20 minutes \nprior to return of spontaneous circulation. Patient was cool on \narrival, and hypothermia protocol was initiated when she arrived \non floor. She was noted to have a prolonged QT interval on EKG \nthroughout her stay, and her K+ and Mg+ were frequently repleted \nto maintain K>4.5 and Mg>2.5. She was hypotensive following \nrewarming, requiring addition of phenylephrine for pressure \nsupport in addition to milrinone. EEG showed evidence of status \nepilepticus, and she was started on keppra and propofol but \ncontinued to seize and fosphenytoin was added. An MRI of the \nhead was performed and showed small areas of infarction \nthroughout the brain. Patient was placed in a pentobarbital \ncoma for 48 hours to suppress seizure activity. She was \ntransitioned from milrinone to dopamine and eventually also \nrequired addition of levophed given her poor urine output and \nrising creatinine. With the addition of levophed she maintained \nMAP in the mid ___ and phenylephrine was successfully weaned \noff. \n.\nFollowing completion of pentobarbital therapy, she remained \nunresponsive with no apprarent brainstem reflexes. She was also \nnoted to have blown pupils on exam on HD 5. Neurology examined \nthe patient and noted that she had no sustained brainstem \nactivity 48 hours after cessation of phenobarb. On HD#7 her HR \nand blood pressure declined despite maximum dopamine and \nlevophed support. A family meeting was held regarding goals of \ncare given her poor neurologic prognosis, and the family elected \nto withdraw care. They requested a chaplain to offer a prayer \nfor the patient and her family. Her pressors and ventilation \nwere discontinued. At 13:40, she passed away with her family at \nbedside. The Medical Examiner's Office accepted the patient for \nautopsy, which the family supports.\n\n# s/p STEMI: It is still unclear why this patient suffered an \nacute STEMI. Initial EKG showed large area of myocardium \naffected. Cardiac cath on day of admission showed lesion in the \nvery distal LAD which was not intervenable. Urine tox negative \nfor cocaine. Significant smoking history. Patient was medically \nmanaged with aspirin, prasugrel, heparin gtt x 48 hrs, \nmetoprolol, and captopril. Echocardiogram performed the day of \nevent showed moderate left ventricular systolic dysfunction with \nmid to distal LV/apical akinesis.\n.\n# Fever/ Leukocytosis: Patient was noted to have temperatures to \n___ F in the setting of cooling in addition to an elevated white \nblood cell count, increased sputum and urine with a large amount \nof sediment. The patient was started on broad spectrum \nantibiotics with vancomycin and cefepime. Culure of the sputum \nSputum grew MSSA and stenotrophomonas (ceftaz-resistant, \nbactrim-sensitive), and urine culture grew citerobacter \n(pan-sensitive). Per ID recommendation patient was started on \nIV nafcillin and IV bactrim as she was unable to take PO \nmedications and could not have levoquin given her long QT. \n.\n# Diabetes Insipidus: On HD 5 patient was noted to be \nhypernatremic with a sodium level of 155. Urine osmolatlity was \nlow suggesting diabetes insipidus, likely central given her \nneurological injury. The patient was given DDAVP 2 mcg IV and \nD5W to replete free water with improvement in her hypernatremia. \nSodium remained stable for the remainder of hospitalization. \n.\n# Transaminitis: The patient was noted to have elevated LFTs on \nadmission believed to be secondary to poor organ perfusion. \nLFTs trended down during hospitalization, but did not return to \nnormal. \n.\n#Normocytic anemia: Hematocrit dropped acutely from 27 to 21.1 \novernight on HD3. There were no obvious signs of GI bleed from \nrectum or OG tube. Smear showed occasional schistocytes, not \nconvincing for active hemolysis. Patient was tranfused 2UPRBCs \non HD4, and hematocrit responded minimally. Reticulocyte count \nwas elevated, supporting appropriate bone marrow functioning.", 'medications_prescribed': ['N/A']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'F', 'symptoms': 'Chest tightness with shortness of breath', 'medical_history': ['HTN', 'HLD', 'GERD'], 'family_history': 'Father ___ cancer\nMother ___\n___ Uncle ___ ___ Stroke\nPaternal Aunt ___ - Type II\nPaternal Grandmother ___ - Type II', 'present_illness': 'Mr. ___ is a ___ yo male with htn, hld, and gerd who \npresented with intermittent chest tightness, lightheadedness, \nand dyspnea on exertion x5 days, with similar prior episode ___ \nyrs ago (neg stress test at that time) who was found to have neg \ntrops x2, normal cath, an elevated D-dimer and large bilat PE \nwith concern for R heart strain on CTA.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QIDACHS', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Imipramine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.24', 'valuenum': 3.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 73 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '179', 'valuenum': 179.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '357', 'valuenum': 357.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '408', 'valuenum': 408.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Tele: NSR ___, one desat to 86%, pt asymptomatic \nVS: T 98.6, BP 107-34/70-94 HR ___ RR ___ O2 sat 97-100 RA \nWeight: 92.6 (admit wt: 92.6 ) \nI/O: ___-___ ___\n\nGENERAL: Well appearing, in NAD. sitting comfortably in bed. \nOriented x3. Mood, affect appropriate. \nHEENT: Conjunctiva were pink, no pallor or cyanosis of the oral \nmucosa. No xanthelasma. \nNECK: Supple with no JVP elevation \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or \nS4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. No abdominal bruits. \n\nEXTREMITIES: No ___ edema. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: 2+ and equal UE and ___', 'diagnoses': [{'icd_code': '5772', 'desc': 'Cyst and pseudocyst of pancreas'}, {'icd_code': '20929', 'desc': 'Malignant carcinoid tumor of other sites'}, {'icd_code': '57420', 'desc': 'Calculus of gallbladder without mention of cholecystitis, without mention of obstruction'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}, {'icd_code': '78702', 'desc': 'Nausea alone'}, {'icd_code': '78321', 'desc': 'Loss of weight'}, {'icd_code': 'V1082', 'desc': 'Personal history of malignant melanoma of skin'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': "___ 09:38PM K+-4.0\n___ 09:31PM ___ PTT-29.9 ___\n___ 06:27PM GLUCOSE-108* UREA N-13 CREAT-1.1 SODIUM-135 \nPOTASSIUM-6.4* CHLORIDE-101 TOTAL CO2-22 ANION GAP-18\n___ 06:27PM estGFR-Using this\n___ 06:27PM cTropnT-<0.01\n___ 06:27PM WBC-6.2 RBC-4.83 HGB-14.6 HCT-43.9 MCV-91 \nMCH-30.2 MCHC-33.3 RDW-14.6 RDWSD-48.6*\n___ 06:27PM NEUTS-57.3 ___ MONOS-8.3 EOS-2.4 \nBASOS-0.6 IM ___ AbsNeut-3.54 AbsLymp-1.92 AbsMono-0.51 \nAbsEos-0.15 AbsBaso-0.04\n___ 06:27PM PLT COUNT-249\nMr. ___ is a ___ yo male with htn, hld, and gerd who \npresented with intermittent chest tightness, lightheadedness, \nand dyspnea on exertion x5 days, with similar prior episode ___ \nyrs ago (neg stress test at that time) who was found to have neg \ntrops x2, normal cath, an elevated D-dimer and large bilat PE \nwith concern for R heart strain on CTA. The pt has no \nidentifiable risk factors such as personal or family history of \nDVTs, recent surgery, travel, or a known malignancy or \ncoagulopathy. \n\n#Bilateral PE: D-dimer of 5241. Large bilat PE on CTA with \nconcern for R heart strain. TTE on ___ showed mild global LV \nhypokinesis (LVEF = 50%) with dilated RV and mild RV global free \nwall hypokinesis, and moderate pulmonary artery systolic \nhypertension. He was started on heparin gtt and transitioned to \nrivaroxiban 15mg BID x3 weeks, to be followed by 20mg daily \nuntil he is advised to stop pending a hypercoagulability workup. \nAntithrombin, protein C and S panels, homocysteine and lupus \nanticoagulant were ordered prior to d/c. Factor V Leiden needs \nto be done as outpt. \n\n#Htn: largely normotensive during this admission. Loasrtan held \nfor cath. Restarted home losartan-HCTZ at discharge. \n\n#Hld: Atorva increased to 80mg while inpt due to concern for \nACS. Pt d/c'd on home dose of atorva 20mg. \n\n#Stimulant use: occasional cocaine use, recent use prior to \nadmission. Pt counseled re role of cocaine in heart disease, \nimportance of complete abstinence. Pt wishes to make sure \ninformation re this substance use remains very private. \nRecommended social work but pt declined."}}
|
{'final_diagnoses': ['Bilateral pulmonary emboli with right heart strain', 'Hypertension', 'hyperlipidemia'], 'procedures': ['Cardiac catheterization'], 'visit_summary': "Mr. ___ is a ___ yo male with htn, hld, and gerd who \npresented with intermittent chest tightness, lightheadedness, \nand dyspnea on exertion x5 days, with similar prior episode ___ \nyrs ago (neg stress test at that time) who was found to have neg \ntrops x2, normal cath, an elevated D-dimer and large bilat PE \nwith concern for R heart strain on CTA. The pt has no \nidentifiable risk factors such as personal or family history of \nDVTs, recent surgery, travel, or a known malignancy or \ncoagulopathy. \n\n#Bilateral PE: D-dimer of 5241. Large bilat PE on CTA with \nconcern for R heart strain. TTE on ___ showed mild global LV \nhypokinesis (LVEF = 50%) with dilated RV and mild RV global free \nwall hypokinesis, and moderate pulmonary artery systolic \nhypertension. He was started on heparin gtt and transitioned to \nrivaroxiban 15mg BID x3 weeks, to be followed by 20mg daily \nuntil he is advised to stop pending a hypercoagulability workup. \nAntithrombin, protein C and S panels, homocysteine and lupus \nanticoagulant were ordered prior to d/c. Factor V Leiden needs \nto be done as outpt. \n\n#Htn: largely normotensive during this admission. Loasrtan held \nfor cath. Restarted home losartan-HCTZ at discharge. \n\n#Hld: Atorva increased to 80mg while inpt due to concern for \nACS. Pt d/c'd on home dose of atorva 20mg. \n\n#Stimulant use: occasional cocaine use, recent use prior to \nadmission. Pt counseled re role of cocaine in heart disease, \nimportance of complete abstinence. Pt wishes to make sure \ninformation re this substance use remains very private. \nRecommended social work but pt declined.", 'medications_prescribed': ['Rivaroxaban 15 mg PO BID \nTake 15mg twice daily for 3 weeks. Take with food.', 'Rivaroxaban 20 mg PO DAILY \nAfter finishing 3 weeks at 15mg twice a day, start taking 20 mg \nonce per day until advised to stop.', 'Albuterol Inhaler ___ PUFF IH Q4H:PRN dyspnea', 'Atorvastatin 20 mg PO QPM', 'losartan-hydrochlorothiazide 50-12.5 mg oral DAILY', 'Omeprazole 20 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 41, 'gender': 'M', 'symptoms': 'mechanical fall', 'medical_history': ['MEDICAL & SURGICAL HISTORY:', '1. Advanced dementia', '2. Permanent pacemaker placement (unknown device, syncope \nepisodes following placement, placed in ___ - last \ninterrogation unknown)', '3. Hypothyroidism', '4. Colonic carcinoma (status-post resection)'], 'family_history': 'No sudden cardiac death, arrhythmia or early cardiovascular \ndisease.', 'present_illness': 'This is a ___ Female with advanced dementia, s/p \npermanent dual-chamber pacemaker placement (___), HTN, \nhypothyroidism presenting after falling at home the morning of \nadmission. Of note, her fall was unwitnessed. Daughter heard a \n"thud" and found the patient on the floor. Believes that she may \nhave tripped as she was walking with a blanket covering her \nwalker. Patient has had multiple mechanical falls at home, \nsustaining several injuries in the past, and has been at rehab \nfacilities previously. She was found to have laceration injuries \nto the face, elbows, and hands. Daughter believes that there was \nno LOC. Patient was yelling to be picked up. Patient did not \ncomplain of lightheadedness or dizziness, chest pain, or \nshortness of breath before the fall. Daughter denies any \nseizure-like activity; no tongue biting, generalized shakes, or \nurinary incontinence. \n. \nOf note, the patient does have a history of syncope for which \ndual-chamber PPM was placed in ___. Daughter states a few more \nepisodes of syncope after pacemaker placement but none recently. \nUnclear if pacemaker has recently been interrogated. \n. \nIn the ED, initial VS 96.2 71 129/89 18 98% RA. Forehead \nlaceration was sutured. She was given 1 mg IV Ativan x 2 and her \nhome dose 25 mg of PO Seroquel. OSH CT head and C-spine were \nreviewed by radiology here, showing type II dens fracture \nwithout neurologic concerns. She was evaluated by Ortho-spine \nwho recommended soft collar vs. ___ until follow-up. Plain \nradiograph of her right hand also showed a non-displaced radial \nhead fracture; Ortho-Trauma recommended OT consult without \nimmobilization.\n. \nCurrently, patient denies pain in her neck or hands. Denies \nnumbness, tingling, or weakness. No headaches or vision changes. \nNo lightheadedness or dizziness. \n. \nREVIEW OF SYSTEMS: Reports chronic constipation. Denies fever, \nchills, night sweats, headache, vision changes, rhinorrhea, \ncongestion, sore throat, cough, shortness of breath, chest pain, \nabdominal pain, nausea, vomiting, diarrhea, dysuria, hematuria.', 'medications': [{'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE-Acetaminophen Elixir', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexameth', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Rocuronium', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nystatin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Clonazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam Oral Solution', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluconazole', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluconazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '40.9', 'valuenum': 40.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 232.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '131', 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'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 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None}, {'value': '1.16', 'valuenum': 1.16, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 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'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.029', 'valuenum': 1.029, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '58', 'valuenum': 58.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.99', 'valuenum': 3.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '192', 'valuenum': 192.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\n.\nVS - 97.6 162/78 81 16 93% RA \nGENERAL - elderly female, NAD, ___ J-collar in place, \ncomfortable \nHEENT - forehead laceration with sutures, EOMI, PERRL, dry MMM, \nOP clear \nNECK - ___ J collar in place; per ortho spine and ED notes, no \nmidline cervical tenderness \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use \nHEART - irregularly irregular, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - anterior forehead laceration, right forearm hematoma, \nright elbow laceration, right hand laceration on dorsum, left \nforearm laceration; active mild bleeding from all lacs \nNEURO - awake, A&Ox1 (baseline), CNs II-XII grossly intact, \nmoving all extremities\n.\nDISCHARGE EXAM:\n.\nVS - 98.6 98.6 138/72 71 22 94% RA \nI/Os: 800 / - | Inc, BM x 3 \nGENERAL - elderly female, NAD, soft collar in place, comfortable \n\nHEENT - forehead laceration with sutures and tegaderm in place, \nEOMI, PERRL, MMM, OP clear \nNECK - soft collar in place; no midline cervical tenderness \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use \nHEART - irregularly irregular, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - anterior forehead laceration, right forearm hematoma, \nright elbow laceration, right hand laceration on dorsum, left \nforearm laceration; no active bleeding \nNEURO - awake, A&O x 1 (to self; baseline), CNs II-XII grossly \nintact, moving all extremities', 'diagnoses': [{'icd_code': '34541', 'desc': 'Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy'}, {'icd_code': '43491', 'desc': 'Cerebral artery occlusion, unspecified with cerebral infarction'}, {'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': 'V6284', 'desc': 'Suicidal ideation'}, {'icd_code': '11284', 'desc': 'Candidal esophagitis'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '7843', 'desc': 'Aphasia'}, {'icd_code': '99702', 'desc': 'Iatrogenic cerebrovascular infarction or hemorrhage'}, {'icd_code': '34881', 'desc': 'Temporal sclerosis'}, {'icd_code': '34291', 'desc': 'Hemiplegia, unspecified, affecting dominant side'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': "ADMISSION LABS: \n.\n___ 02:55PM BLOOD WBC-7.0 RBC-3.67 Hgb-11.7 Hct-34.7 \nMCV-95* MCH-32.0* MCHC-33.8 RDW-13.0 Plt ___\n___ 02:55PM BLOOD Neuts-71.8* Lymphs-21.8* Monos-3.7 \nEos-2.2 Baso-0.4\n___ 02:55PM BLOOD ___ PTT-30.2 ___\n___ 02:55PM BLOOD Glucose-112* UreaN-28* Creat-1.4* Na-139 \nK-5.5* Cl-104 HCO3-25 AnGap-16\n___ 02:55PM BLOOD TSH-0.44\n___ 04:13PM BLOOD K-4.4\n.\nDISCHARGE LABS: \n.\n___ 11:25PM BLOOD WBC-8.2 RBC-3.57* Hgb-11.6* Hct-34.2* \nMCV-96 MCH-32.4* MCHC-33.8 RDW-14.5 Plt ___\n___ 11:25PM BLOOD Plt ___\n___ 11:25PM BLOOD Glucose-145* UreaN-25* Creat-1.3* Na-140 \nK-4.3 Cl-106 HCO3-22 AnGap-16\n___ 11:25PM BLOOD Calcium-9.2 Phos-3.0 Mg-2.0\n.\nMICROBIOLOGIC DATA:\n.\n___ Urine culture - pending\n.\nEKG (___): A.fib @ ___, LAD, IVCD, QTc 449 msec, evidence of \nesacpe junctional rhythm?, no ST-changes\n.\nIMAGING STUDIES:\n___ CT HEAD W/O CONTRAST - No acute intracranial process. \nModerate small vessel disease, expected for the patient's age.\n.\n___ CT C-SPINE W/O CONTRAST - Nondisplaced type 2 dens \nfracture, indeterminate of the age, but likely acute.\n.\n___ BILAT HIPS (AP,LAT & AP) - No fractures.\n.\n___ CHEST (SINGLE VIEW) - No acute cardiothoracic process.\n.\n___ HAND/ELBOW (AP, LAT & OBLIQUE) - Probable right radial \nhead fracture with jopijnt effusion iat the right elbow. \nOsteoarthritis in the left hand most pronounced at the ___ CMC \njoint. No fracture in the left elbow or hand.\n\nStudies pending on discharge: \nUrine culture showed 10,000-100,000 gram negative rods. \nSpeciation pending\n___ yo F with a PMH significant for advanced dementia, s/p \npermanent dual-chamber pacemaker placement (___), hypertension, \nand hypothyroidism admitted after a mechanical fall and found to \nhave non-displaced radial head fracture and type II odontoid \nfracture without neurologic compromise.\n \n#MECHANICAL FALLS: \nThe patient has a history of multiple mechanical falls now \npresenting from home after falling at home, sustaining type II \ndens fracture and non-displaced right radial head fracture. \nHistorical elements consistent with mechanical fall; family \nbelieves there was no LOC, CT head was reassuring. Other \npossible etiologies were considered, included cardiac and \nneurogenic causes, although the falls seem mechanical. We did \nask electrophysiology to interrogate her pacemaker device given \nthe concern for syncope, but this was reassuring. Her TSH was \nchecked and was normal, 0.44. An EKG showed atrial fibrillation \nwith intermittent ventricular pacing. There was no evidence of \nseziure activity and she had reassuring glucose measurement. She \nwas maintained on telemetry. An infectious work-up was employed \nand showed a positive U/A with pending culture. We opted to \ntreat with 3-days of Bactrim DS. Physical therapy evaluated the \npatient and a family discussion was engaged, and it was felt \nthat rehab was the proper placement for her. A discussion will \nbe had in the future about whether she will return home to be in \nthe care of her daughter.\n. \n# TYPE II ODONTOID PROCESS FRACTURE, NON-DISPLACED RIGHT RADIAL \nHEAD FRACTURE - An outside hospital CT C-spine read by radiology \nhere showed a type II dens fracture. She was evaluated by \nOrtho-spine who recommended that she be placed in a ___ hard \ncollar or soft cervical collar until follow-up with spine clinic \nin 2-weeks. Patient was without spinal point tenderness - she \nhad no midline tenderness or paresthesias of the upper \nextremities. The non-displaced right radial head fracture was \nstable and she remained neurovascularly intact. She will be \ndischarged with the soft collar for comfort and with physical \ntherapy and occupational therapy consultation at rehab. Her pain \nwas controlled with Tylenol and her neurologic exam was \nreassuring. We opted not to start vitamin D and calcium given \nher age, although likely osteoporosis and mechanical \nfall-induced fractures should be noted.\n. \n# ACUTE RENAL FAILURE - The patient's creatinine was elevated to \n1.4 on admission, her baseline was unknown but the patient has \nno known diagnosis of chronic kidney disease. Per her daughter, \nthe patient drinks little water and did not urinate the day \nprior to admission. Prerenal azotemia likely from volume \ndepletion given her clinical history and dry mucous membranes on \nadmission was the most consistent etiology. She received gentle \nIV hydration with improvement in creatinine. Her creatinine \nremained at 1.3-1.4 on discharge.\n.\n# ATRIAL FIBRILLATION - The patient presented with atrial \nfibrillation that has been rate controlled without AV-nodal \nblocking agents; she is on no anticoagulation - of unknown \nduration. Patient has been having syncopal episodes, but related \nlikely to mechanical falls rather than syncope. Pacer \ninterrogation this admission reveals DDD mode with appropriate \npacemaker function. In DDD there is fusion pacing with the \nnative QRS complex. She has tolerated this well. She has had a \nnumber of episodes of atrial tachycardia and probable atrial \nfibrillation with no episode lasting longer than 9.6 hours and \nmost less than one hour. No high rate episodes were detected\nat the time of the patient's fall. We deferred rhythm control \nand anticoagulation given her age and fall risk.\n. \n# ADVANCED DEMENTIA - Per her daughter, the patient knows self \nbut is not oriented to place or date. Does not recognize family \nat baseline. Daughter denies history of aspiration; states that \npatient eats soft diet at home with thin liquids. We continued \nher home doses of Seroquel 25 mg PO QID and Ativan 1 mg PO QHS. \n\n. \n# HYPOTHYROIDISM - TSH 0.44 (normal) this admission. We \ncontinued Levothyroxine 88 mcg PO daily. \n. \nTRANSITION OF CARE ISSUES:\n1. Urine culture pending at the time of discharge. Treated with \n3-days of Bactrim DS given a positive urinalysis without \ninterpretable symptoms. End date ___. \n2. Consider vitamin D and calcium supplementation given her \nmechanical falls and resulting fractures; although minimizing \nmedications given her age is appropriate as well.\n3. Please remove forehead laceration sutures in ___ days (placed \non admission ___. Keep wounds clean, dry with triple \nantibiotic ointment placement and non-adhesive kerlex gauze wrap \nas needed.\n4. Fall precautions.\n5. Consider additional low dose of Seroquel 25 mg PO added in \nthe evenings for agitation or sundowning, as needed.\n6. Physical and occupational therapy.\n7. For her cervical (odontoid process) fracture, patient may \nwear soft collar or ___ hard collar for comfort, as needed. \nNo other limitations.\n8. For right wrist fracture, patient has no activity \nrestrictions and requires no splint device."}}
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{'final_diagnoses': ['Primary Diagnoses:', '1. Mechanical fall', '2. Non-displaced right radial head fracture', '3. Type II odontoid (dens) fracture', '4. Renal insufficiency (unclear if acute versus chronic)', '5. Urinary tract infection', '.', 'Secondary Diagnoses:', '1. Advanced dementia', '2. Permanent pacemaker placement ', '3. Hypothyroidism'], 'procedures': ['None this hospitalization'], 'visit_summary': "___ yo F with a PMH significant for advanced dementia, s/p \npermanent dual-chamber pacemaker placement (___), hypertension, \nand hypothyroidism admitted after a mechanical fall and found to \nhave non-displaced radial head fracture and type II odontoid \nfracture without neurologic compromise.\n \n#MECHANICAL FALLS: \nThe patient has a history of multiple mechanical falls now \npresenting from home after falling at home, sustaining type II \ndens fracture and non-displaced right radial head fracture. \nHistorical elements consistent with mechanical fall; family \nbelieves there was no LOC, CT head was reassuring. Other \npossible etiologies were considered, included cardiac and \nneurogenic causes, although the falls seem mechanical. We did \nask electrophysiology to interrogate her pacemaker device given \nthe concern for syncope, but this was reassuring. Her TSH was \nchecked and was normal, 0.44. An EKG showed atrial fibrillation \nwith intermittent ventricular pacing. There was no evidence of \nseziure activity and she had reassuring glucose measurement. She \nwas maintained on telemetry. An infectious work-up was employed \nand showed a positive U/A with pending culture. We opted to \ntreat with 3-days of Bactrim DS. Physical therapy evaluated the \npatient and a family discussion was engaged, and it was felt \nthat rehab was the proper placement for her. A discussion will \nbe had in the future about whether she will return home to be in \nthe care of her daughter.\n. \n# TYPE II ODONTOID PROCESS FRACTURE, NON-DISPLACED RIGHT RADIAL \nHEAD FRACTURE - An outside hospital CT C-spine read by radiology \nhere showed a type II dens fracture. She was evaluated by \nOrtho-spine who recommended that she be placed in a ___ hard \ncollar or soft cervical collar until follow-up with spine clinic \nin 2-weeks. Patient was without spinal point tenderness - she \nhad no midline tenderness or paresthesias of the upper \nextremities. The non-displaced right radial head fracture was \nstable and she remained neurovascularly intact. She will be \ndischarged with the soft collar for comfort and with physical \ntherapy and occupational therapy consultation at rehab. Her pain \nwas controlled with Tylenol and her neurologic exam was \nreassuring. We opted not to start vitamin D and calcium given \nher age, although likely osteoporosis and mechanical \nfall-induced fractures should be noted.\n. \n# ACUTE RENAL FAILURE - The patient's creatinine was elevated to \n1.4 on admission, her baseline was unknown but the patient has \nno known diagnosis of chronic kidney disease. Per her daughter, \nthe patient drinks little water and did not urinate the day \nprior to admission. Prerenal azotemia likely from volume \ndepletion given her clinical history and dry mucous membranes on \nadmission was the most consistent etiology. She received gentle \nIV hydration with improvement in creatinine. Her creatinine \nremained at 1.3-1.4 on discharge.\n.\n# ATRIAL FIBRILLATION - The patient presented with atrial \nfibrillation that has been rate controlled without AV-nodal \nblocking agents; she is on no anticoagulation - of unknown \nduration. Patient has been having syncopal episodes, but related \nlikely to mechanical falls rather than syncope. Pacer \ninterrogation this admission reveals DDD mode with appropriate \npacemaker function. In DDD there is fusion pacing with the \nnative QRS complex. She has tolerated this well. She has had a \nnumber of episodes of atrial tachycardia and probable atrial \nfibrillation with no episode lasting longer than 9.6 hours and \nmost less than one hour. No high rate episodes were detected\nat the time of the patient's fall. We deferred rhythm control \nand anticoagulation given her age and fall risk.\n. \n# ADVANCED DEMENTIA - Per her daughter, the patient knows self \nbut is not oriented to place or date. Does not recognize family \nat baseline. Daughter denies history of aspiration; states that \npatient eats soft diet at home with thin liquids. We continued \nher home doses of Seroquel 25 mg PO QID and Ativan 1 mg PO QHS. \n\n. \n# HYPOTHYROIDISM - TSH 0.44 (normal) this admission. We \ncontinued Levothyroxine 88 mcg PO daily. \n. \nTRANSITION OF CARE ISSUES:\n1. Urine culture pending at the time of discharge. Treated with \n3-days of Bactrim DS given a positive urinalysis without \ninterpretable symptoms. End date ___. \n2. Consider vitamin D and calcium supplementation given her \nmechanical falls and resulting fractures; although minimizing \nmedications given her age is appropriate as well.\n3. Please remove forehead laceration sutures in ___ days (placed \non admission ___. Keep wounds clean, dry with triple \nantibiotic ointment placement and non-adhesive kerlex gauze wrap \nas needed.\n4. Fall precautions.\n5. Consider additional low dose of Seroquel 25 mg PO added in \nthe evenings for agitation or sundowning, as needed.\n6. Physical and occupational therapy.\n7. For her cervical (odontoid process) fracture, patient may \nwear soft collar or ___ hard collar for comfort, as needed. \nNo other limitations.\n8. For right wrist fracture, patient has no activity \nrestrictions and requires no splint device.", 'medications_prescribed': ['1. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. quetiapine 25 mg Tablet Sig: One (1) Tablet PO QID (4 times a \nday).', '3. lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).', '4. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic EVERY \nOTHER DAY (Every Other Day): to both eyes.', '5. acetaminophen 325 mg Tablet Sig: ___ Tablets PO every ___ \nhours as needed for pain.', '6. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) \nTablet PO BID (2 times a day) for 3 doses: started ___, end \ndate ___. Disp:*3 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 66, 'gender': 'F', 'symptoms': 'postmenopausal bleeding', 'medical_history': ['GASTROESOPHAGEAL REFLUX', 'GYNECOLOGIC', 'HYPERCHOLESTEROLEMIA', 'HYPERTENSION', 'LICHEN SIMPLEX CHRONICUS', 'OBESITY', 'PULMONARY NODULE', 'SLEEP APNEA', 'URINARY INCONTINENCE', 'FIBROID UTERUS', 'DIABETES TYPE II', 'H/O CIGARETTE ABUSE'], 'family_history': 'Mother with tuberculosis. No family history of gynecologic or \nbreast cancers.', 'present_illness': 'From consultation with Dr. ___ on ___:\n\nMs. ___ is a ___ who has been on HRT for over ___ years and \nunderwent an US in ___ in the setting of postmenopausal \nbleeding. An EMB was attempted but insufficient. She then was \nlost to care as she underwent a hip replacement. She returned \nto care in ___ and was a SIS with EMB was performed in ___. \n US was notable for an enlarged uterus which measured 16.2 x 9.3 \nx 10.0 cm, previously 11.8 x 10.2 x 8.7 cm (___). Uterine \nfibroids were present. The largest fibroid exhibits internal \ncalcification and measures 6.4 x 7.4 x 7.9 cm, previously 6.8 \ncm.\n\nDue to distortion from the fibroids, the endometrium could not \nbe visualized initially. A sonohysterogram was performed by Dr. \n___ views of the endometrium remained distorted due to \nfibroids however, there was an echogenic focal endometrial \nlesion demonstrating cystic spaces measuring 11 x 9 mm. EMB \nshowed predominantly mucous with scant fragments of atrophic \nendometrium.\n\nThe patient was referred to Urogyn for evaluation of urinary \nincontinence and a sensation of incomplete emptying. She reports \nurinary urgency and frequency. She is voiding small amounts at \nhome and having what seems to be overflow incontinence episodes \nat times. UDS testing was notable for incomplete emptying with a \nquestion of outlet obstruction due to enlarging fibroids.\n \nPatient states that she was placed on bioidentical hormones to \nhelp with chronic vulvar itching. She was diagnosed with lichen \nsclerosis in her ___. She was seen recently by dermatology at \ntwice daily ___ and clobetasol was recommended. She thinks \nshe had a biopsy many years ago. She has a known fibroid which \nhas been present for "4 decades."', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '354', 'valuenum': 354.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 21.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '320', 'valuenum': 320.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Initial Physical Exam:\nPhysical Examination: Vital Signs: General: She is well \ngroomed, well-appearing woman who appears her stated age and is \nin no acute distress.\nNeck: Supple, without palpable masses or cervical adenopathy.\nLungs: Normal respiratory effort. \nAbdomen: Soft, nontender and nondistended.\nExtremities: Nontender without edema or limitations.\nPelvic: She has normal external female genitalia with smooth \ninner labial folds. There is a normal urethral meatus. The \nvaginal walls were smooth without lesions. The cervix is normal \nin appearance without lesions. There is a small amount of \ndischarge in the vault. On bimanual exam, the uterus is enlarged \nwith a smooth anterior mobile mass. There are no adnexal masses.\n\nPhysical Exam on Discharge:\nGeneral: NAD, resting comfortably in bed, A&Ox3, husband present \nat bedside\nCV: RRR\nLungs: LCTAB, no respiratory distress\nAbd: soft, nontender, no rebound/guarding, large hematoma across \nlower abdomen and left flank, marked with surgical marking pen \nand improving\nIncision: drainage incisions on anterior lower abdomen with 4x4 \nand tegaderm dressing in place, 5 well-healing port sites, skin \nwell approximated, c/d/I without drainage\nExtremities: no calf tenderness/erythema, pneumoboots in place', 'diagnoses': [{'icd_code': '82101', 'desc': 'Closed fracture of shaft of femur'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': 'V0382', 'desc': 'Other specified vaccinations against streptococcus pneumoniae [pneumococcus]'}], 'summary': "___ 10:11AM FIBRINOGE-UNABLE TO \n___ 10:11AM ___ TO PTT-UNABLE TO ___ \nTO \n___ 10:11AM PLT COUNT-468*#\n___ 10:11AM NEUTS-72.9* LYMPHS-12.2* MONOS-12.5 EOS-0.8* \nBASOS-0.4 IM ___ AbsNeut-8.59* AbsLymp-1.44 AbsMono-1.48* \nAbsEos-0.10 AbsBaso-0.05\n___ 10:11AM WBC-11.8* RBC-2.80* HGB-7.8* HCT-23.6* MCV-84 \nMCH-27.9 MCHC-33.1 RDW-14.7 RDWSD-46.0\n___ 10:11AM CALCIUM-8.4 PHOSPHATE-3.9 MAGNESIUM-1.3*\n___ 10:11AM estGFR-Using this\n___ 10:11AM GLUCOSE-130* UREA N-15 CREAT-0.5 SODIUM-130* \nPOTASSIUM-3.8 CHLORIDE-87* TOTAL CO2-25 ANION GAP-18\n___ 12:10PM OTHER BODY FLUID FluAPCR-NEGATIVE \nFluBPCR-NEGATIVE\n___ 01:37PM ___ PTT-27.5 ___\nMs. ___ is a ___ year old woman who underwent a \nrobotic-assisted total laparoscopic hysterectomy, bilateral \nsalpingoophorectomy, and mini-laparotomy, cystoscopy on ___ \nfor postmenopausal bleeding who was admitted to the gynecologic \noncology service with fever, vaginal bleeding, and general \nmalaise on ___. She was febrile to Tmax 103 at home and \nT101 in triage ___. She was started on levofloxacin and \nflagyl. \n\nThe patient's vaginal bleeding resolved in triage, and had no \nevidence of vaginal cuff dehiscence on exam. She had a large \nabdominal wall hematoma which was marked and stable. On hospital \nday 1, her Hct was Hct was 23.6, consistent with acute blood \nloss anemia, and she was transfused one unit of packed RBCs. \nDuring her transfusion of second unit of blood, she became \nfebrile to T 102.8. She had just been pretreated with Tylenol \ngiven that her temperature after the 1st unit of blood was \n100.6. Patient denied any other symptoms except for continued \nback pain and feeling weak, which were initial presenting \ncomplaints that originally brought her in for evaluation. Her \ntransfusion of second pack of RBCs was stopped and a type and \nscreen along with the unit of blood was sent for investigation \nper discussion with blood bank resident. Given that her only new \nsymptom was fever and she had an infection in which we were \nalready actively treating, the elevated temperature was likely \ndue to her baseline infection rather than a true transfusion \nreaction. Her Hct remained stable thereafter at 26.9 and \nimproved to 29.4 during her admission.\n\nOn CT scan on hospital day ___, she was found to have a 7 cm \npelvic abscess at surgical site and 3.2cm anterior abdominal \nwall hematoma. She had a pigtail catheter placed ___ which \ndrained 25cc of fluid which was noted to be blood-tinged, \nfeculent and purulent. Please see the procedure report for full \ndetails. However, there was a low suspicion for bowel \nperforation based on clinical findings and imaging. Output \nremained thin red-brown fluid consistent with a resolving pelvic \nhematoma. Gram stain revealed gram negative rods and culture \nrevealed pan-sensitive E Coli. Her blood culture revealed no \ngrowth. Her UA on ___ was within normal limits. Her pain was \ncontrolled with oxycodone and Tylenol inpatient. Patient \nremained afebrile on antibiotics and without further episodes of \nvaginal bleeding since admission on ___. \n\nA follow-up CT scan on ___ showed no evidence of bowel \nperforation and the pelvic abscess with drain in place had \nresolved, therefore the pigtail catheter was removed on ___. \nThe CT scan on ___ also showed a new organizing small abscess \nin anterior pelvis, and an abdominal ultrasound on ___ showed \nmultiple contiguous anterior abdominal collections, largest \n9x2cm, adjacent to loops of bowel. The patient underwent a CT \nguided drainage of anterior collection on ___ by \ninterventional radiology. Per report, multiple attempts were \nmade at aspirating 2 of the collections, however only minimal \naltered blood was aspirated from 1 of the collections, which \nwere likely evolving hematomas. Sample was sent for \nmicrobiology evaluation. Please see the procedure report for \nfull details. \n\nShe was seen by social work and worked with physical therapy \nwhile inpatient. By hospital day 9, she had remained afebrile \nsince ___ on oral antibiotics, had no further episodes of \nvaginal bleeding inpatient, was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was then discharged home \nin stable condition with outpatient follow-up scheduled and home \n___ visits arranged."}}
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{'final_diagnoses': ['anterior peritoneal wall abscess', 'abdominal collection', 'acute blood loss anemia'], 'procedures': ['___ guided drainage of two collections', 'blood transfusion on 1 unit packed red blood cells'], 'visit_summary': "Ms. ___ is a ___ year old woman who underwent a \nrobotic-assisted total laparoscopic hysterectomy, bilateral \nsalpingoophorectomy, and mini-laparotomy, cystoscopy on ___ \nfor postmenopausal bleeding who was admitted to the gynecologic \noncology service with fever, vaginal bleeding, and general \nmalaise on ___. She was febrile to Tmax 103 at home and \nT101 in triage ___. She was started on levofloxacin and \nflagyl. \n\nThe patient's vaginal bleeding resolved in triage, and had no \nevidence of vaginal cuff dehiscence on exam. She had a large \nabdominal wall hematoma which was marked and stable. On hospital \nday 1, her Hct was Hct was 23.6, consistent with acute blood \nloss anemia, and she was transfused one unit of packed RBCs. \nDuring her transfusion of second unit of blood, she became \nfebrile to T 102.8. She had just been pretreated with Tylenol \ngiven that her temperature after the 1st unit of blood was \n100.6. Patient denied any other symptoms except for continued \nback pain and feeling weak, which were initial presenting \ncomplaints that originally brought her in for evaluation. Her \ntransfusion of second pack of RBCs was stopped and a type and \nscreen along with the unit of blood was sent for investigation \nper discussion with blood bank resident. Given that her only new \nsymptom was fever and she had an infection in which we were \nalready actively treating, the elevated temperature was likely \ndue to her baseline infection rather than a true transfusion \nreaction. Her Hct remained stable thereafter at 26.9 and \nimproved to 29.4 during her admission.\n\nOn CT scan on hospital day ___, she was found to have a 7 cm \npelvic abscess at surgical site and 3.2cm anterior abdominal \nwall hematoma. She had a pigtail catheter placed ___ which \ndrained 25cc of fluid which was noted to be blood-tinged, \nfeculent and purulent. Please see the procedure report for full \ndetails. However, there was a low suspicion for bowel \nperforation based on clinical findings and imaging. Output \nremained thin red-brown fluid consistent with a resolving pelvic \nhematoma. Gram stain revealed gram negative rods and culture \nrevealed pan-sensitive E Coli. Her blood culture revealed no \ngrowth. Her UA on ___ was within normal limits. Her pain was \ncontrolled with oxycodone and Tylenol inpatient. Patient \nremained afebrile on antibiotics and without further episodes of \nvaginal bleeding since admission on ___. \n\nA follow-up CT scan on ___ showed no evidence of bowel \nperforation and the pelvic abscess with drain in place had \nresolved, therefore the pigtail catheter was removed on ___. \nThe CT scan on ___ also showed a new organizing small abscess \nin anterior pelvis, and an abdominal ultrasound on ___ showed \nmultiple contiguous anterior abdominal collections, largest \n9x2cm, adjacent to loops of bowel. The patient underwent a CT \nguided drainage of anterior collection on ___ by \ninterventional radiology. Per report, multiple attempts were \nmade at aspirating 2 of the collections, however only minimal \naltered blood was aspirated from 1 of the collections, which \nwere likely evolving hematomas. Sample was sent for \nmicrobiology evaluation. Please see the procedure report for \nfull details. \n\nShe was seen by social work and worked with physical therapy \nwhile inpatient. By hospital day 9, she had remained afebrile \nsince ___ on oral antibiotics, had no further episodes of \nvaginal bleeding inpatient, was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was then discharged home \nin stable condition with outpatient follow-up scheduled and home \n___ visits arranged.", 'medications_prescribed': ['Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever \ndo not take more than 4000mg in 24 hours \nRX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours as \nneeded Disp #*50 Tablet Refills:*1 ', 'Levofloxacin 750 mg PO Q24H \nRX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*6 \nTablet Refills:*0 ', 'MetroNIDAZOLE 500 mg PO Q8H \nRX *metronidazole 500 mg 1 tablet(s) by mouth take every 8 hours \nDisp #*20 Tablet Refills:*0 ', 'Atorvastatin 40 mg PO QPM', 'Hydrochlorothiazide 25 mg PO DAILY', 'Levothyroxine Sodium 125 mcg PO DAILY', 'Lisinopril 5 mg PO DAILY', 'Metoprolol Succinate XL 50 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 81, 'gender': 'M', 'symptoms': 'Leg swelling', 'medical_history': ['DM2', 'CHF', 'DIABETIC AMYOTROPHY', 'DEPRESSION', 'HYPERCHOLESTEROLEMIA', 'HYPERTENSION', 'GOUT', '?STROKE', 'ATYPICAL CHEST PAIN', 'CHARCOT FOOT', 'PERIPHERAL NEUROPATHY', 'CHRONIC KIDNEY DISEASE', 'IRON DEF ANEMIA', 'CELLULITIS', 'DYSPNEA', 'H/O HEP C'], 'family_history': 'mother has DM2, stroke, hypertension; father has\nemphysema; sister has breast cancer', 'present_illness': 'Patient is a ___ year old female, history of CHF and DM2 w/\nperipheral neuropathy, who presents with bilateral leg swelling,\nleft > right. \nPatient reports that 3 days ago, she noticed worsening bilateral\nlower extremity edema, worse in the L leg. L leg also had a\nburning pain, spreading from the foot to the knee. \nPatient also endorses some SOB with exertion over the past \ncouple\nof months, although this has been unchanged during the course of\nher worsening ___ edema. \nDenies orthopnea. Denies fevers, chills. \nShe saw her PCP at this time, where it was noted that she was\n6lbs above her dry weight of 202lbs. PCP instructed her to\nrestart her spironolactone, which she was not able to fill \nbefore\nthis admission. \nNotably, patient was discharged from ___ about 1 month prior\nfor a CHF exacerbation, but patient reports that the pain is \nmore\nsevere than that episode and is now unilateral. \nPatient has also had a cyst under her L great toenail for the\npast several months, which has recently begun to be more \npainful.\nPatient notes occasional clear discharge from the toenail. \nDenies chest pain, no change in bowel or bladder function. \nDenies\nheadache or change in vision or hearing.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Clonazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Doxazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '368', 'valuenum': 368.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '238', 'valuenum': 238.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '991', 'valuenum': 991.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \n========================\nVITALS: 24 HR Data (last updated ___ @ 2241)\nTemp: 98.8 (Tm 98.8), BP: 192/79, HR: 102, RR: 18, O2 sat:\n92%, O2 delivery: Ra, Wt: 209.6 lb/95.07 kg \nGEN: overall well, NAD\nHEENT: anicteric sclera, no cervical lymphadenopathy, no\nthyromegaly\nCardiac: RRR, audible S1 S2, no m/r/g\nPulm: CTAB, no increased work of breathing\nAbd: normoactive bowel sounds, nontender, nondistended, no\norganomegaly\nL leg/foot: ___ pitting edema, warm to touch, tender to\npalpation, mild crusting around great toenail\nR leg/foot: ___ pitting edema, not warm to touch, nontender to\npalpation\nNeuro: A&O x3, no gross deficits\n\nDISCHARGE PHYSICAL EXAM:\n========================\n24 HR Data (last updated ___ @ 922)\nTemp: 98.0 (Tm 98.4), BP: 152/74 (114-153/52-74), HR: 56 \n(54-61),\nRR: 20 (___), O2 sat: 98% (94-99), O2 delivery: RA, Wt: 209.1\nlb/94.85 kg \nGEN: overall well, NAD\nHEENT: anicteric sclera, no cervical lymphadenopathy, no\nthyromegaly, JVP not elevated.\nCardiac: RRR, audible S1 S2, no m/r/g\nPulm: CTAB, no increased work of breathing\nAbd: normoactive bowel sounds, nontender, nondistended, no\norganomegaly\nL leg/foot: no significant edema to upper shins, warm to touch,\nmild crusting around great toenail, erythema much improved from\nmarked area, hyperpigmented plaques in inverted champagne bottle\nappearance, no TTP anterior aspect of left ankle. No gross\ndeformities noted to this area. No pain with active df/pf on the\nleft. no open lesions noted.\nR leg/foot: no significant edema to upper shins, not warm to\ntouch, nontender to palpation, hyperpigmented plaques in \ninverted\nchampagne bottle appearance, TTP sub ___ met head due to bony\nprominence. No open lesions noted. TTP between digits ___. \nPossibly heloma mole. \nNeuro: A&Ox3, no gross deficits', 'diagnoses': [{'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '33182', 'desc': 'Dementia with lewy bodies'}, {'icd_code': '29410', 'desc': 'Dementia in conditions classified elsewhere without behavioral disturbance'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '32742', 'desc': 'REM sleep behavior disorder'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '28529', 'desc': 'Anemia of other chronic disease'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': 'V1052', 'desc': 'Personal history of malignant neoplasm of kidney'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}], 'summary': "___ 06:32AM BLOOD WBC-8.8 RBC-3.41* Hgb-9.7* Hct-30.1* \nMCV-88 MCH-28.4 MCHC-32.2 RDW-15.1 RDWSD-48.9* Plt ___\n___ 12:15PM BLOOD WBC-9.5 RBC-3.58* Hgb-10.3* Hct-31.5* \nMCV-88 MCH-28.8 MCHC-32.7 RDW-15.2 RDWSD-48.6* Plt ___\n___ 07:00AM BLOOD Glucose-105* UreaN-93* Creat-4.5* Na-133* \nK-5.4 Cl-101 HCO3-13* AnGap-19*\n___ 06:35AM BLOOD Glucose-98 UreaN-88* Creat-4.4* Na-134* \nK-5.2 Cl-98 HCO3-15* AnGap-21*\n___ 06:32AM BLOOD Glucose-191* UreaN-84* Creat-4.5* Na-135 \nK-5.1 Cl-99 HCO3-17* AnGap-19*\n___ 03:25PM BLOOD Glucose-191* UreaN-78* Creat-4.0* Na-134* \nK-5.1 Cl-95* HCO3-21* AnGap-18\n___ 06:44AM BLOOD Glucose-152* UreaN-80* Creat-4.3*# Na-138 \nK-5.4 Cl-100 HCO3-18* AnGap-20*\n___ 06:48AM BLOOD Glucose-168* UreaN-66* Creat-3.0* Na-138 \nK-4.4 Cl-99 HCO3-17* AnGap-22*\n___ 06:29AM BLOOD Glucose-161* UreaN-57* Creat-2.0* Na-140 \nK-4.5 Cl-99 HCO3-22 AnGap-19*\n___ 04:42PM BLOOD Glucose-121* UreaN-26* Creat-1.5* Na-143 \nK-4.0 Cl-104 HCO3-27 AnGap-12\n___ 07:00AM BLOOD Glucose-42* UreaN-24* Creat-1.6* Na-146 \nK-3.8 Cl-106 HCO3-27 AnGap-13\n___ 03:15PM BLOOD Glucose-262* UreaN-24* Creat-1.6* Na-141 \nK-4.0 Cl-103 HCO3-26 AnGap-12\n___ 04:42PM BLOOD cTropnT-0.02* proBNP-515\n___ 07:00AM BLOOD Calcium-9.1 Phos-7.2* Mg-2.7*\n___ 06:35AM BLOOD Calcium-9.6 Phos-7.4* Mg-2.7*\n___ 06:32AM BLOOD Calcium-9.3 Phos-7.1* Mg-2.___CTIVE ISSUES:\n===============\n# Heart Failure exacerbation with bilateral Lower extremity \nedema, left > right\nMrs. ___ presented severely volume overloaded on exam. She \nwas having difficulty taking deep breaths, but vital signs were \nstable at room air and had extensive lower extremity edema; left \nleg was worse than the right side. She was diuresed using \nintravenous 20mg Lasix and daily spironolactone 100mg daily with \nclinical improvement. Her hypertensive medication carvedilol was \nincreased from 12.5mg to 25mg. We also added lisinopril 10mg \ndaily as her systolic blood pressure remained in the 150s. This \naugmentation lead to improvement of her blood pressure. \nUltimately her heart failure exacerbation was attributed to \neither her cellulitis or multifactorial hypertensive \nnon-adherence. Her admission weight was 209lbs, and her \ndischarged weight is 209 due to setbacks of her ___. \n\n___\nAfter intravenous 20mg lasix, Mrs. ___ was nearly at her dry \nweight. We decided to discontinue her the drip and restart her \non her home dose of Torsemide 100mg BID. However, we noticed her \ncreatinine was up-trending from her baseline of 1.6. We \ndiscontinue her home Torsemide and lisinopril and gave her a \n250cc of fluids to improve her kidney function with no \nimprovement in her creatinine levels. Her Fractional excretion \nof Urea indicated pre-renal from either hypovolemic or \noverloaded. We dosed her with a 160ml bolus of lasix with no \nimprovement. Her weight also continued to increase back to her \nadmission weight. Nephrology was consulted and suggested to \ncontinue to diuresis. She was given another 160ml bolus of lasix \nwith 10mg lasix drip. Her Cr improved and continues to downtrend \nand is currently at 2.0 with her weight being down to 199. \nHowever, her Cr up-trended to 4.5 after starting on lisinopril. \nLisinopril was held and torsemide per recommendations from \nnephrology. Her Cr continues to be elevated but stabilized over \nthe past 5 days and has been restarted back on her home \ntorsemide. Nephrology okay with discharge with stabilized Cr \nlevels. She will follow up with nephrology-Dr. ___ at ___ \nthis week for further management of this. \n\n#Acidosis \nPatient's bicarbonate levels have been down-trending since she \nstarted the lisinopril. Her current level/lowest is at 13. \nHowever, this can be attributable to her mild diarrhea and loss \nof appetite. She was given 1300mg of sodium bicarbonate. \n\n# Cellulitis\nOn presentation her left lower extremity was warm, tender, and \nhad a history of diabetic neuropathy,\nunilateral difference suggest cellulitis in the left leg. We \nstarted her on IV ceftriaxone 1gm and eventually switched her \nover to oral Keflex ___ with a total of 7 days being on \nantibiotics. Her cellulitis resolved with treatment. \nAlternatively, her swelling was ruled out with lower extremity \nvenous Doppler which was negative for possible DVT. Blood \ncultures were negative for growth. \n\n#HTN\nPatient presented with BP 192/79 with persistently high \npressures in ED as well. Uncontrolled BP could have contributed \nto HFpEF exacerbation. Carvedilol was increased to 25mg BID from \n12.5mg BID and she was started on lisinopril 5mg daily then \neventually increased to lisinopril 10mg daily with improvement \nof her blood pressure. However her lisinopril was held in the \nsitting of ___. However, her medication regimen is suboptimal. \nShe has been on spironalactone 100 mg since at least ___, with \nunclear reasons. I suspect spironolactone 100mg is preventing \nher from being on an ideal regimen (esp w/ her kidney disease). \n\n\nCHRONIC ISSUES\n#DM2\nSymptomatic hypoglycemia morning of ___. At home, she takes 36u \nTresiba and gives mealtime insulin doses. ___ was consulted, \nand decreased home Glargine dose to 20u + SSI. Januvia was held. \n\n\n#CKD\nCreatinine elevated at baseline to 1.4-1.6, with an uptrend to \nthe highest levels have been to 2.7.\nAs described above. Renal ultrasound was obtained which did not \ndemonstrate renal artery stenosis.\n\n# Constipation\nShe was continued on her home regimen of docusate sodium. \n\nTRANSITIONAL ISSUES:\n===================="}}
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{'final_diagnoses': ['Heart failure with preserved ejection fraction', 'Cellulitis', 'Hypertension', 'Diabetes type II', 'Gout', 'Chronic kidney disease', 'Diabetes Mellitus type II', 'Constipation'], 'procedures': ['None'], 'visit_summary': "# Heart Failure exacerbation with bilateral Lower extremity \nedema, left > right\nMrs. ___ presented severely volume overloaded on exam. She \nwas having difficulty taking deep breaths, but vital signs were \nstable at room air and had extensive lower extremity edema; left \nleg was worse than the right side. She was diuresed using \nintravenous 20mg Lasix and daily spironolactone 100mg daily with \nclinical improvement. Her hypertensive medication carvedilol was \nincreased from 12.5mg to 25mg. We also added lisinopril 10mg \ndaily as her systolic blood pressure remained in the 150s. This \naugmentation lead to improvement of her blood pressure. \nUltimately her heart failure exacerbation was attributed to \neither her cellulitis or multifactorial hypertensive \nnon-adherence. Her admission weight was 209lbs, and her \ndischarged weight is 209 due to setbacks of her ___. \n\n___\nAfter intravenous 20mg lasix, Mrs. ___ was nearly at her dry \nweight. We decided to discontinue her the drip and restart her \non her home dose of Torsemide 100mg BID. However, we noticed her \ncreatinine was up-trending from her baseline of 1.6. We \ndiscontinue her home Torsemide and lisinopril and gave her a \n250cc of fluids to improve her kidney function with no \nimprovement in her creatinine levels. Her Fractional excretion \nof Urea indicated pre-renal from either hypovolemic or \noverloaded. We dosed her with a 160ml bolus of lasix with no \nimprovement. Her weight also continued to increase back to her \nadmission weight. Nephrology was consulted and suggested to \ncontinue to diuresis. She was given another 160ml bolus of lasix \nwith 10mg lasix drip. Her Cr improved and continues to downtrend \nand is currently at 2.0 with her weight being down to 199. \nHowever, her Cr up-trended to 4.5 after starting on lisinopril. \nLisinopril was held and torsemide per recommendations from \nnephrology. Her Cr continues to be elevated but stabilized over \nthe past 5 days and has been restarted back on her home \ntorsemide. Nephrology okay with discharge with stabilized Cr \nlevels. She will follow up with nephrology-Dr. ___ at ___ \nthis week for further management of this. \n\n#Acidosis \nPatient's bicarbonate levels have been down-trending since she \nstarted the lisinopril. Her current level/lowest is at 13. \nHowever, this can be attributable to her mild diarrhea and loss \nof appetite. She was given 1300mg of sodium bicarbonate. \n\n# Cellulitis\nOn presentation her left lower extremity was warm, tender, and \nhad a history of diabetic neuropathy,\nunilateral difference suggest cellulitis in the left leg. We \nstarted her on IV ceftriaxone 1gm and eventually switched her \nover to oral Keflex ___ with a total of 7 days being on \nantibiotics. Her cellulitis resolved with treatment. \nAlternatively, her swelling was ruled out with lower extremity \nvenous Doppler which was negative for possible DVT. Blood \ncultures were negative for growth. \n\n#HTN\nPatient presented with BP 192/79 with persistently high \npressures in ED as well. Uncontrolled BP could have contributed \nto HFpEF exacerbation. Carvedilol was increased to 25mg BID from \n12.5mg BID and she was started on lisinopril 5mg daily then \neventually increased to lisinopril 10mg daily with improvement \nof her blood pressure. However her lisinopril was held in the \nsitting of ___. However, her medication regimen is suboptimal. \nShe has been on spironalactone 100 mg since at least ___, with \nunclear reasons. I suspect spironolactone 100mg is preventing \nher from being on an ideal regimen (esp w/ her kidney disease). \n\n\nCHRONIC ISSUES\n#DM2\nSymptomatic hypoglycemia morning of ___. At home, she takes 36u \nTresiba and gives mealtime insulin doses. ___ was consulted, \nand decreased home Glargine dose to 20u + SSI. Januvia was held. \n\n\n#CKD\nCreatinine elevated at baseline to 1.4-1.6, with an uptrend to \nthe highest levels have been to 2.7.\nAs described above. Renal ultrasound was obtained which did not \ndemonstrate renal artery stenosis.\n\n# Constipation\nShe was continued on her home regimen of docusate sodium. \n\nTRANSITIONAL ISSUES:\n====================", 'medications_prescribed': ['CARVedilol 25 mg PO BID \nyou were taking 12.5mg. We would like you to take 25mg twice a \nday for blood pressure. ', 'Tresiba U-100 Insulin (insulin degludec) 100 unit/mL \nsubcutaneous DAILY \nTRESIBA INSULIN 24 UNITS AT BEDTIME:\n\nIF BEDTIME BLOOD SUGAR IS: \n<120- TAKE 18 UNITS OF TRESIBA\n121-150 TAKE 20 UNITS OF TRESIBA\n151-200 TAKE 24 UNITS OF TRESIBA\n200-250 TAKE 28 UNITS OF TRESIBA\n251-300 TAKE 32 UNITS OF TRESIBA\n>300 TAKE 36 UNITS OF TRESIBA\n\n ', 'Acetaminophen 1000 mg PO Q8H ', 'Allopurinol ___ mg PO DAILY ', 'Artificial Tears ___ DROP BOTH EYES Q4H:PRN dry eyes ', 'Aspirin 81 mg PO DAILY ', 'Bengay Cream 1 Appl TP BID to legs for pain ', 'BusPIRone 5 mg PO DAILY ', 'Calcitriol 0.25 mcg PO DAILY ', 'Docusate Sodium 100 mg PO BID ', 'DULoxetine ___ 30 mg PO BID ', 'Januvia (SITagliptin) 25 mg oral DAILY ', 'Ketorolac 0.5% Ophth Soln 1 DROP BOTH EYES BID ', 'OxyCODONE (Immediate Release) 15 mg PO Q4H:PRN PAIN - \nmoderate to severe ', 'Polyethylene Glycol 17 g PO TID:PRN Constipation - First \nLine \n Reason for PRN duplicate override: Alternating agents for \nsimilar severity ', 'PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP BOTH EYES BID ', 'Rosuvastatin Calcium 10 mg PO QPM ', 'Senna 17.2 mg PO BID ', 'Torsemide 100 mg PO BID ', 'HELD- Spironolactone 100 mg PO DAILY This medication was \nheld. Do not restart Spironolactone until you follow up with \nyour PCP.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'M', 'symptoms': 'Shortness of breath', 'medical_history': ['Rheumatoid Arthritis', 'CAD', 'HTN', 'HL', 'DM2'], 'family_history': 'Noncontributory', 'present_illness': 'Per admission note:\n\n___ w/ CAD s/p cath w/ multivessel disease, HTN, HLD, DM, RA on \nhumira, p/w acute on chronic SOB x 1 week. Pt report shortness \nof breath and sore throat that began on ___ for which he called \nhis PCP and was scheduled an appt on ___. Over the course of pt \ndeveloped worsening productive cough, dark beige in color. On \nmorning of ___, pt felt he was "suffocating" and could not wait \nfor his appt and presented to the ED. He denies any fevers, \nchills but has been having drenching night sweats. Denies any \nleg trauma, immobilization. Also denies chest pain but reports \npressure with difficulty breathing. \n \nOf note, pt reported also feeling unwell on ___ and noting per \nhis vitals machine that although his BP was stable his heart \nrate jumped into the 140s and was irregular, consistent with his \nPAF. He reports being very symptomatic, with SOB, palp, \nlightheadedness. \n \nIn the ED, initial vitals : T98.5 HR83 BP138/71 RR20 O295. Labs \nwere sig for neg CEs, DD 760, Lactate 3.1 ->1.7, Cr 1, proBNP \n1025, WBC 7.3, HCT 37, PLT 319. He received ASA 325, Lovenox and \nLasix 20mg IV.', 'medications': [{'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Methotrexate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Leucovorin Calcium', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Leucovorin Calcium', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Leucovorin Calcium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Leucovorin Calcium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.00', 'valuenum': 1.0, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53.7', 'valuenum': 53.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.26', 'valuenum': 0.26, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.53', 'valuenum': 1.53, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.95', 'valuenum': 0.95, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.1', 'valuenum': 67.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '228', 'valuenum': 228.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.35', 'valuenum': 0.35, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.77', 'valuenum': 2.77, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '41.8', 'valuenum': 41.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.86', 'valuenum': 0.86, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65.5', 'valuenum': 65.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.38', 'valuenum': 0.38, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.43', 'valuenum': 2.43, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '43.0', 'valuenum': 43.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.2, 'valueuom': 'umol/L', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Therapeutic guidelines:. 24 hours < 5.0 umol/l. 48 hours < 1.0 umol/l. 72 hours < 0.2 umol/l. for results prior to ___, see send-out system.'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': 'umol/L', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Therapeutic guidelines:. 24 hours < 5.0 umol/l. 48 hours < 1.0 umol/l. 72 hours < 0.2 umol/l. for results prior to ___, see send-out system.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.80', 'valuenum': 0.8, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73.8', 'valuenum': 73.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '248', 'valuenum': 248.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.36', 'valuenum': 0.36, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.52', 'valuenum': 3.52, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '41.8', 'valuenum': 41.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1, . estimated GFR (eGFR) is likely between 69 and >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.4, 'valueuom': 'umol/L', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Therapeutic guidelines:. 24 hours < 5.0 umol/l. 48 hours < 1.0 umol/l. 72 hours < 0.2 umol/l. for results prior to ___, see send-out system.'}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.35', 'valuenum': 4.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60.9', 'valuenum': 60.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.08', 'valuenum': 2.08, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '40.1', 'valuenum': 40.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.46, 'valueuom': 'umol/L', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Therapeutic guidelines:. 24 hours < 5.0 umol/l. 48 hours < 1.0 umol/l. 72 hours < 0.2 umol/l. for results prior to ___, see send-out system.'}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.14, 'valueuom': 'umol/L', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Therapeutic guidelines:. 24 hours < 5.0 umol/l. 48 hours < 1.0 umol/l. 72 hours < 0.2 umol/l. for results prior to ___, see send-out system.'}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On discharge:\nGENERAL: Pleasant, well appearing male in NAD, sitting up on \nedge of bed, speaking in complete sentences. \nHEENT: Normocephalic, atraumatic. No conjunctival pallor. No \nscleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No \nLAD, No thyromegaly. \nCARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, \nrubs or ___. no JVD \nLUNGS: Bibasilar crackles. Good air movement. \nABDOMEN: NABS. Soft, NT, ND. No HSM \nEXTREMITIES: 1+ edema of ankles and shins, 1+ distal pulses, no \ncalf tenderness. \nSKIN: No rashes/lesions, ecchymoses. \nNEURO: A&Ox3. Appropriate. CN ___ grossly intact. Preserved \nsensation and full strength throughout. Normal coordination. \nGait assessment deferred \nPSYCH: Listens and responds to questions appropriately, pleasant', 'diagnoses': [{'icd_code': 'Z5111', 'desc': 'Encounter for antineoplastic chemotherapy'}, {'icd_code': 'C8589', 'desc': 'Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites'}, {'icd_code': 'E876', 'desc': 'Hypokalemia'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z8619', 'desc': 'Personal history of other infectious and parasitic diseases'}], 'summary': '___ 06:15AM BLOOD WBC-5.8 RBC-4.20* Hgb-12.0* Hct-35.9* \nMCV-86 MCH-28.5 MCHC-33.3 RDW-14.1 Plt ___\n___ 09:45AM BLOOD Neuts-60.9 ___ Monos-7.9 Eos-2.2 \nBaso-0.7\n___ 06:15AM BLOOD ___ PTT-33.2 ___\n___ 06:15AM BLOOD Ret Aut-2.4\n___ 06:15AM BLOOD Glucose-136* UreaN-22* Creat-1.0 Na-140 \nK-4.2 Cl-102 HCO3-26 AnGap-16\n___ 03:40PM BLOOD CK(CPK)-80\n___ 03:40PM BLOOD cTropnT-<0.01\n___ 09:45AM BLOOD CK-MB-3 proBNP-1025*\n___ 06:15AM BLOOD Calcium-8.9 Phos-4.0 Mg-2.3 Iron-53\n___ 06:15AM BLOOD calTIBC-391 VitB12-236* Folate-GREATER TH \nFerritn-77 TRF-301\n___ 01:06PM BLOOD D-Dimer-760*\n___ 10:07AM BLOOD Lactate-3.1*\n___ 03:49PM BLOOD Lactate-1.7\n\nBlood cultures NGTD\n\nPA/LAT CXR ___:\nPersistent cardiomegaly, but new from ___, raises the \npossibility of a slow decompensation. \n\nCTA chest ___:\n1. Pulmonary embolism in the subsegmental pulmonary arteries \nsupplying the \nleft lower lobe and right middle lobe. \n2. Cardiomegaly, interlobular septal thickening, basilar \nground-glass \nopacities, and small bilateral pleural effusions, all of which \nare consistent with mild pulmonary edema. \n3. Focal area of airspace consolidation in the right upper lobe \nwhich may \nrepresent superimposed infection. However, focal alveolar edema \ncannot \nentirely be excluded. \n4. Mediastinal lymphadenopathy which may be reactive in nature, \nhowever, \nfollowup to resolution is recommended.\n___ yo M with h/o PAF, CAD, HTN, HL, RA presents with worsening \nSOB and found to have several subsegmental PEs. \n \n## PEs: Unclear cause, given no injury, immobility, no history \nor evidence of malignancy or prior PE. Started on Lovenox in ED \nand added onto coumadin. Per pt he had not tolerated coumadin in \nthe past for his afib, but on furthur probing, he was unsure of \nwhat the side effect was and was willing to restart it knowning \nits benefits in the current situation. On discharge, pt was \ngiven Rx for Coumadin 5mg and Lovenox ___ BID for 7d, with \nplan for INR check and results to be sent to Dr ___. His INR on \ndischarge was 1.5 in the setting of no interacting medications. \n \n## CHF: On presentation pt was slightly fluid overloaded with a \npro BNP 1025. Pt reports no home use of lasix, and last recorded \nEF was normal on cath. Pt was reevalauted with transthoracic \necho while in house and results pending at time of discharge. He \nwas treated with Lasix 40mg PO while in house and discharged on \n20mg daily, to be adjusted based on final results of echo. \n\n## CAD: Pt remained chest pain free throughout the admission and \nwas continued on BB, statin, ___, and CCB with some switch to \nequivalent formulary medications temporarilily\n \n## HTN: Well controlled on CCB, ___, BB \n \n## HL: Pt was continued on statin which he tolerated well\n\n## DM2: Oral regimen was held while in house and pt managed with \ninsulin sliding scale. Oral meds were restarted on discharge. \n \n## Rheumatoid Arthritis: Pt was not due to Humira while in house \nand may need to be reassessed prior to restarting given slightly \nincreased risk of hypercoagulability. \n \n## Anemia: Pt had normocytic anemia stable at mid ___ down from \nprior baseline of 40. There was no evidence of bleeding and \nanemia panel was sent and pending at time of discharge.'}}
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{'final_diagnoses': ['Pulmonary emboli', 'Coronary Artery Disease', 'Hypertension', 'Hyperlipidemia', 'Paroxysmal Atrial fibrillation', 'Rheumatoid Arthritis'], 'procedures': ['None'], 'visit_summary': '___ yo M with h/o PAF, CAD, HTN, HL, RA presents with worsening \nSOB and found to have several subsegmental PEs. \n \n## PEs: Unclear cause, given no injury, immobility, no history \nor evidence of malignancy or prior PE. Started on Lovenox in ED \nand added onto coumadin. Per pt he had not tolerated coumadin in \nthe past for his afib, but on furthur probing, he was unsure of \nwhat the side effect was and was willing to restart it knowning \nits benefits in the current situation. On discharge, pt was \ngiven Rx for Coumadin 5mg and Lovenox ___ BID for 7d, with \nplan for INR check and results to be sent to Dr ___. His INR on \ndischarge was 1.5 in the setting of no interacting medications. \n \n## CHF: On presentation pt was slightly fluid overloaded with a \npro BNP 1025. Pt reports no home use of lasix, and last recorded \nEF was normal on cath. Pt was reevalauted with transthoracic \necho while in house and results pending at time of discharge. He \nwas treated with Lasix 40mg PO while in house and discharged on \n20mg daily, to be adjusted based on final results of echo. \n\n## CAD: Pt remained chest pain free throughout the admission and \nwas continued on BB, statin, ___, and CCB with some switch to \nequivalent formulary medications temporarilily\n \n## HTN: Well controlled on CCB, ___, BB \n \n## HL: Pt was continued on statin which he tolerated well\n\n## DM2: Oral regimen was held while in house and pt managed with \ninsulin sliding scale. Oral meds were restarted on discharge. \n \n## Rheumatoid Arthritis: Pt was not due to Humira while in house \nand may need to be reassessed prior to restarting given slightly \nincreased risk of hypercoagulability. \n \n## Anemia: Pt had normocytic anemia stable at mid ___ down from \nprior baseline of 40. There was no evidence of bleeding and \nanemia panel was sent and pending at time of discharge.', 'medications_prescribed': ['1. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. Enoxaparin 100 mg/mL Syringe Sig: One (1) injection \nSubcutaneous Q12H (every 12 hours) for 7 days.\nDisp:*14 injection* Refills:*0*', '5. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day.\nDisp:*60 Tablet(s)* Refills:*2*', '6. Outpatient Lab Work\nPlease have INR checked on ___ ___ office at \n___, phone ___', '7. Amlodipine-Olmesartan ___ mg Tablet Sig: One (1) Tablet PO \nonce a day.', '8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO twice a day.', '10. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.', '11. Bystolic 2.5 mg Tablet Sig: One (1) Tablet PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'Scheduled R. main bronchus tumor resection', 'medical_history': ['Melanoma, back, ___- s/p wide local excision in ___ in \n___, ___.', 'H/o basal cell carcinoma, left lower eyelid in ___', 'Depression', 'Anxiety', 'Post traumatic stress syndrome', 'Head tremor since age ___', 's/p fall in ___ due to morphine OD, requiring intubation and \n7 day ICU stay. Morphine OD in the setting of arguments with \nmother and daughter, and took morphine thinking that it will \nhelp her to sleep.', 's/p fibroid resection', 's/p tonsillectomy and adenoidectomy', 's/p appendectomy', 's/p C section'], 'family_history': '- Brother with recently diagnosed esophageal/gastric cancer, age \n___. \n- Mother ___ with bladder cancer, CHF, aortic stenosis. \n- Father died on home hospice at age ___. He had CHF and CRI. \nPatient took care of her father while on hospice', 'present_illness': '___ yo F with h/o superficial melanoma back in ___ ___ per \npatient) now with recently diagnosed metastatic melanoma to the \nright main bronchus, presents for scheduled R. main bronchial \nmass removal.\n\nPatient was recently evaluated by IP and oncology for biopsy \nproven melanoma via endobronchial biopsy on bronchoscpy for a \nright mainstem tumor. Per patient, her symptoms started in ___ when she first noted right sided wheeze, that sounded like \n"meow" when she "push her voice out". She also felt that her \n"lungs were going to burst" ___ she swam. It resolved \nspontaneously by ___. However, then recurred and developed \nnon-productive cough, DOE, and burning sensation in the chest \nwith exertion. She was treated with albuterol, antibiotics, and \nthen steroid, but did not improve. Eventaully, she had a CT scan \n___ that showed a large mediastinal mass that partially \noccludes her right mainstem bronchus. Subsequently, she had a \nbronchoscopy with endobronchial biopsies by Dr. ___ in \npulmonology, showing a right mainstem bronchus mass < 2 cm from \ncarina, nearly completely occluding the bronchus on ___. \nBiopsy confirmed melanoma. PET on ___ showed moderate \nhypermetaolism to the mass and another lesion in the RUL. \n\nShe was then evaluated by Dr. ___ from thoracic \nsurgery on ___ who thought her lung lesion would require \npneumonectomy and could be a challenging surgery due to location \nof the tumor. She was also evaluated by Dr. ___ in \noncology and Dr. ___ in radiation oncology on \n___. Palliative radiation was discussed and brain MRI was \nrecommended to complete staging. Radiation simulation was to be \nundertaken.\n \nIn the ED, initial VS T 98.1, HR 90, BP 168/100, RR 16, O2Sat \n100% RA. Prelim read of CXR without signs of pneumothorax, \nconsolidation, or mass. \n\nCurrently, she reports shortness of breath on and off. Often, \nshe feels better when she lies flat on her back, worse when she \nlies on her side. She reports her breathing to be like a \n"whistle", "bubbly" or "crackly" at night when she sleeps. She \noften has to take clonazepam to help with her head tremor and to \nsleep. She has non-productive cough and mid-substernal pain \n___ with breathing at times. She was just started on \nciprofloxacin about 3 days ago for UTI, with the plan for a 7 \nday course. She continues to have some urinary urgency and \nfrequency but not dysuria.', 'medications': [{'medication': 'Racepinephrine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Duloxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Racepinephrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Duloxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'MR X1', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '___', 'valuenum': 1.39, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.1, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '400', 'valuenum': 400.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 463.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.25, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 339.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.13, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': 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'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.32', 'valuenum': 3.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical Exam on Admission:\nVS - Temp 98.5 F, BP 125/87, HR 95, R 18, O2-sat 98% RA \nGENERAL- pale appearing female in NAD, comfortable, appropriate\nHEENT: NC/AT, PERRLA, EOMi, sclera anicteric, MMM, OP clear with \nmild post-nasal drip \nNECK- supple, no thyromegaly, no JVD, no LAD\nLUNGS- inspiratory and expiratory bronchial wheeze worse on the \nright, no crackles or rhonchi, respiratory unlabored, no \naccessory muscle use. \nHEART- PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN- soft/NT/ND, no masses or HSM, no rebound/guarding\nEXTREMITIES- no c/c/e, 2+ dorsalis pedis pulses bilaterally \nSKIN- no melanic lesions noted on the skin. Multiple brown nevi \nscattered throughout. small < 1 cm diameter erythematous dry \nscaly macule consistent with actinic keratosis\nBack: large midline vertical scar from previous excision, no \nback pain on palpation\nNEURO - awake, A&Ox3, CNs ___ grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout. \n\nPhysical Exam on Discharge: ', 'diagnoses': [{'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '20280', 'desc': 'Other malignant lymphomas, unspecified site, extranodal and solid organ sites'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '0413', 'desc': "Friedländer's bacillus infection in conditions classified elsewhere and of unspecified site"}, {'icd_code': '36846', 'desc': 'Homonymous bilateral field defects'}, {'icd_code': '7810', 'desc': 'Abnormal involuntary movements'}], 'summary': 'Labs on Admission:\n___ 02:00PM BLOOD WBC-5.3 RBC-4.45 Hgb-13.4 Hct-38.4 MCV-86 \nMCH-30.1 MCHC-34.9 RDW-15.3 Plt ___\n___ 02:00PM BLOOD Neuts-57.0 ___ Monos-4.7 Eos-1.7 \nBaso-0.8\n___ 02:00PM BLOOD ___ PTT-23.4 ___\n___ 02:00PM BLOOD Glucose-98 UreaN-15 Creat-0.8 Na-139 \nK-3.8 Cl-104 HCO3-25 AnGap-14\n___ 02:00PM URINE Color-Straw Appear-Clear Sp ___\n___ 02:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG\n\nLabs on Discharge\n___ 08:10AM BLOOD WBC-7.6 RBC-4.21 Hgb-12.8 Hct-38.1 MCV-91 \nMCH-30.5 MCHC-33.7 RDW-15.5 Plt ___\n___ 08:10AM BLOOD Glucose-121* UreaN-16 Creat-0.8 Na-142 \nK-4.2 Cl-107 HCO3-26 AnGap-13\n\nMicrobiology\n___ Urine Culture- negative\n___ Bronchoalveolar Lavage: No PMN, 2+ GPC in pairs, > \n100,000 organisms/mL commensal respiratory flora \n\nStudies:\n___\n- CXR: ONE VIEW OF THE CHEST: The lungs are well expanded. \nCompared to prior outside studies, again noted is the oblong and \nperipheral nodular opacity corresponding to the impacted and \ndilated bronchial to the right upper lobe. Patient has biopsy \nproven bronchial melanoma metastasis. No superimposed \nconsolidation or edema is noted. The cardiomediastinal \nsilhouette, hilar contours, and pleural surfaces are normal. No \npleural effusions are present. \nIMPRESSION: No acute process. Stable dilated impacted right \nupper lobe bronchial as above.\n\n___\n- Upper Lobe Tumor pathology pending\n- Bronchoscopy report pending\n___ yo F with h/o superficial melanoma back in ___ ___ II per \npatient) now has recently diagnosed metastatic melanoma to the \nright main bronchus, presented with some SOB and scheduled R. \nmain bronchial mass removal, admitted on ___ and \ndischarged on ___.# Melanoma, right mainstem bronchus. This is biopsy proven. \nThis is most likely metastasis from previous melanoma back in \n___, although her skin exam up to ___ were all within normal. \nHer risk factors include previous history of melanoma, severe \nsun burn, and fair skin. Her prognosis is not ideal given that \nshe has multiple sites of metastsis- right mainstem bronchus and \nRUL. Patient underwent bronchoscopy with mechanical debridement \non ___ without complication. The plan is to have \nphotodynamic therapy in the near future to further treat the \ntumor. Follow-up date with IP could not be set up at the time \nof discharge, because patient needs to arrange care for her \nmother to come back to ___ for a week long therapy. Social \nwork gave patient information on available resources. Her \nspecialists were contacted regarding the plan. She has \nfollow-up appointment set up with her primary care physician as \nwell as her local oncologist. She was also urged to set up with \nIP once she finds help for her mother, so that PDT can be \narranged.# Urinary tract infection. Patient was diagnosed with UTI in \nthe outpatient setting. She completed a total of 3 day course \nof antibiotics using ciprofloxacin. Her UA and urine culture \nduring this hospital course were negative. This can be followed \nup by her primary care physician should symptoms of UTI recurr.# Depression/PTSD/anxiety. Stable. Patient was kept on home \ndose cymbalta. She received trazodone for sleep as needed while \nin the hospital. Her clonazepam also given as an prn basis at \n0.5 mg BID given. She was discharged on her home medication \nwithout changes. She was recommended to follow up with her \ntherapist/psychiatrist.# Code: Full# Health Care Proxy- Daughter, ___ in ___ '}}
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{'final_diagnoses': ['Metastatic melanoma', 'Urinary tract infection'], 'procedures': ['Bronchoscopy and tumor debridement on ___'], 'visit_summary': '___ yo F with h/o superficial melanoma back in ___ ___ II per \npatient) now has recently diagnosed metastatic melanoma to the \nright main bronchus, presented with some SOB and scheduled R. \nmain bronchial mass removal, admitted on ___ and \ndischarged on ___.# Melanoma, right mainstem bronchus. This is biopsy proven. \nThis is most likely metastasis from previous melanoma back in \n___, although her skin exam up to ___ were all within normal. \nHer risk factors include previous history of melanoma, severe \nsun burn, and fair skin. Her prognosis is not ideal given that \nshe has multiple sites of metastsis- right mainstem bronchus and \nRUL. Patient underwent bronchoscopy with mechanical debridement \non ___ without complication. The plan is to have \nphotodynamic therapy in the near future to further treat the \ntumor. Follow-up date with IP could not be set up at the time \nof discharge, because patient needs to arrange care for her \nmother to come back to ___ for a week long therapy. Social \nwork gave patient information on available resources. Her \nspecialists were contacted regarding the plan. She has \nfollow-up appointment set up with her primary care physician as \nwell as her local oncologist. She was also urged to set up with \nIP once she finds help for her mother, so that PDT can be \narranged.# Urinary tract infection. Patient was diagnosed with UTI in \nthe outpatient setting. She completed a total of 3 day course \nof antibiotics using ciprofloxacin. Her UA and urine culture \nduring this hospital course were negative. This can be followed \nup by her primary care physician should symptoms of UTI recurr.# Depression/PTSD/anxiety. Stable. Patient was kept on home \ndose cymbalta. She received trazodone for sleep as needed while \nin the hospital. Her clonazepam also given as an prn basis at \n0.5 mg BID given. She was discharged on her home medication \nwithout changes. She was recommended to follow up with her \ntherapist/psychiatrist.# Code: Full# Health Care Proxy- Daughter, ___ in ___ ', 'medications_prescribed': ['duloxetine 60 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO once a day.', 'clonazepam 0.5 mg Tablet Sig: ___ Tablets PO BID (2 times a \nday) as needed for anxiety.', 'acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain, fever.', 'Benadryl 25 mg Capsule Sig: ___ Capsules PO at bedtime as \nneeded for insomnia.']}
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