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Ebere Nwoji DOB: 11/02/78 CC: S: Followup hypertension.

2011124

12/16/13

Patient is a 35-year-old African-American female, who presents today for evaluation of blood pressure control. She is takin !darbyclor "#$%5 one tablet daily as well as had addition of diltia&em 3'# m to the re imen after her blood pressure was elevated. She reports no side effects to the diltia&em. She had previously been on !darbi, spironolactone, metoprolol and diltia&em before pre nancy back in %#(%. She reports no chest pain, shortness of breath, or palpitations. She has not been e)ercisin and is plannin a trip to *i eria. She is a nonsmoker. Family history is si nificant for hypertension. +itals, As above. -eneral, .bese, pleasant female, in no acute distress. /!!*0, Pupils are reactive to li ht and accommodation. !)traocular movements are intact. Funduscopic e)am is within normal limits. 1un s, 20A3. 2+, 444 without 54-. !)tremities, *o edema, cyanosis, or clubbin . /ypertension, still needin improvement in control. Patient will continue !darbyclor "#$%5 and diltia&em 3'# m , but add the metoprolol back. She will take metoprolol 5# m to her re imen and take this daily. She is encoura ed to e)ercise and maintain 6AS/ diet. She is also encoura ed to eat breakfast and lunch. .ften she will skip these meals and continue to work on eatin better as well. Follow up with me in three to four weeks7 time to reevaluate. She will check potassium at that time. A3,rme$A*83(#%'9(

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Anu 3ommareddi, 56

Joanne M Pri e DOB: 02/1!/!7 CC: S:

2001112

12/16/13

Followup type % diabetes, hypertension, le pain. Patient is a 5'-year-old 2aucasian female, who presents today for evaluation of the above. She has been takin her metformin :5# m two tablets daily without difficulty, takin it with lunch and dinner. She reports no polyuria, polypha ia, or polydipsia. 1ast hemo lobin A(c was elevated at :.%. She has since then lost %" pounds. She is eatin better, e)ercisin . She states she was swimmin on Friday where she felt a cramp in her le . ;t has been there since this time. She has tried usin some ;cy/ot with minimal improvement. She reports no other in<ury or trauma. She is on lisinopril %# m for blood pressure control. She reports no chest pain, shortness of breath, or palpitations. She is a nonsmoker. Family history is si nificant for dad with hypertension and dyslipidemia. +itals, As above. -eneral, 5orbidly obese, pleasant female, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. Abdomen, Soft, *0$*6. *o or anome aly, no masses. *o rebound, uardin , peritoneal si ns. !)tremities, *o edema, cyanosis, or clubbin . !)amination of the ri ht le reveals some tenderness alon the astrocnemius. (. %. 3. 4i ht lower le calf pain, likely secondary to strain. Patient is recommended to do some stretches, take some anti-inflammatories as needed. She will also check 25P lookin at potassium and calcium levels. 0ype % diabetes. Patient will check hemo lobin A(c. 2ontinue metformin :5# m one tablet b.i.d. 2ontinue A6A diet and e)ercise. She is commended on her wei ht loss. /ypertension, stable. 2ontinue lisinopril %# m . Follow up in three months7 time. A3,rme$A*83(#%'9%

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Anu 3ommareddi, 56

Co""in# $%i&e'ie"( DOB: 08/24/80 CC: S: 2hest pain, an)iety attack.

2002846

12/16/13

Patient is a 33-year-old 2aucasian female with a history of A66 and mi raine headaches, who presents today with a two-episode history of feelin chest pressure. She reports feelin as somebody is sittin on her chest and started feelin short of breath and her heart was racin . She does state that it feels like an an)iety attack. She has a history of an)iety and does report feelin more an)ious at this time of the year with the holidays and carin for two children at home she is nursin . She says with one of the episodes she took =ana) and she felt much better. She has been e)ercisin and reports her chest pain to not occur durin e)ertion. She has not been short of breath and$or havin palpitations durin the time of e)ertion. She reports no known family history si nificant for depression or an)iety. She is an e)-smoker. +itals, As above. -eneral, >ell-developed, well-nourished female, stable mood and affect, normal speech pattern and tone, no psychomotor retardation, in no acute distress. *eck, >ithout thyrome aly. 1un s, 20A3. 2+, 444 without 54-. Abdomen, Soft, *0$*6. *o or anome aly, no masses. *o rebound, uardin , peritoneal si ns. !)tremities, *o edema, cyanosis, or clubbin . A (%-lead !?- is obtained, which shows normal sinus rhythm at a rate of about '# beats per minute. 0here are no S0-0 wave chan es and no @ waves noted. 2hest pressure, likely secondary to an)iety, possibly secondary to this time of year. 3ased on this, the patient is started on escitalopram 5 m one tablet daily after side effects and benefits discussed. She will start this and she was iven =ana) #.5 m half a tablet to use as needed at bedtime. She was iven A%#. She will follow up with me in two to three weeks7 time, sooner for any worsenin of issues. She is aware if she has any chest pain associated with e)ertion, she is to o immediately to the emer ency room and would likely need stress test. Patient is in a reement. A3,rme$A*83(#%'93

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Anu 3ommareddi, 56

*a&"+nn ) ,ar(+ DOB: 02/12/-1 CC: S:

2008632

12/16/13

>ants to chan e birth control options. Patient is a %%-year-old African-American female with a history of asthma, who presents today wantin to chan e birth control options. She has been on 6epo-Provera since %#(# and reports that she feels like she has mood chan es with it and would like to try birth control pills. She is in a stable mono amous relationship, currently usin condoms. She had a pre nancy test done at ur ent care. She was treated for a 80; last weekend that was ne ative. She reports no concerns about bein pre nant. She is <ust interested in tryin to chan e contraceptive methods. Patient is a nonsmoker and no history of clots. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. !)tremities, *o edema, cyanosis, or clubbin . 2ontraception in a patient with mood chan es on 6epo-Provera. She is switched to Aviane one tablet daily after side effects and benefits discussed. She was iven three packs. She will follow up with me in two to three months7 time to reevaluate. >e discussed risks includin blood clots and the fact that she should have a withdrawal bleed after three weeks7 time. Patient was also iven a flu shot today without difficulty. A3,rme$A*83(#%'9"

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Anu 3ommareddi, 56

Caro" M S.ea# DOB: 04/28/4! CC: S:

1037-23

12/16/13

Followup hypertension and dyslipidemia. Patient is a ':-year-old 2aucasian female, who presents today for evaluation of the above. She has been doin well, takin Procardia =1 B# m as well as lisinopril "# m and metoprolol 5# m . She reports no chest pain, shortness of breath, or palpitations. She is also takin 1ipitor %# m without myal ias, nausea, vomitin , or abdominal pain. She had labs done at 4alei h !ndocrine, which showed normal liver function. She did have a bump up in her creatinine to (." and is currently seein 4alei h *ephrolo y with re ards to this. /er 161 was normal at '5 and /61 was C(. +itals, As above. -eneral, .bese pleasant female, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. !)tremities, *o edema, cyanosis, or clubbin . (. %. /ypertension, stable. 2ontinue Procardia =1 B# m , lisinopril "# m , and metoprolol 5# m . 6yslipidemia. Patient7s lipid panel and liver function look normal. 2ontinue 1ipitor %# m . Follow up in three months7 time. A3,rme$A*83(#%'95

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Anu 3ommareddi, 56

/e"e ia * $i""ia0# DOB: 08/16/7! CC: S:

103-!37

12/16/13

>ei ht ain, va inal dischar e, difficulty sleepin . Patient is a 3:-year-old African-American female, status post astric bypass in %##B, who presents today with complaints of wei ht ain. 8pon reviewin chart, she has picked up 5 pounds since last February and feels like she has picked up a lot more than that. She is able to eat more and is still e)ercisin , tryin to watch what she eats, but despite that is ainin wei ht. She has also had some constipation and dry skin and is wonderin if her thyroid that was checked in February was in the normal ran e. She also describes va inal dischar e, not associated with odor, itchin , or concerns about S06. She is not se)ually active. She reports no fever, chills, or itchin . She 11111207:473 clear increased dischar e. Finally, she complains of difficulty with sleep. She has a hard time fallin asleep. She has been usin cou h medicine and this helped, but is concerned about takin this lon term. She has a family history si nificant for mom and siblin s with hypertension. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. *eck, >ithout thyrome aly. 1un s, 20A3. 2+, 444 without 54-. Abdomen, Soft, *0$*6. *o or anome aly, no masses. *o rebound, uardin , peritoneal si ns. !)tremities, *o edema, cyanosis, or clubbin . (. %. 3. >ei ht ain with constipation. Patient will have check of 0S/ and we will await results of this. 4ecommended she continue cuttin back on calories in diet and increasin activity level. +a inal dischar e. 6escribe it sounds like normal hormonal chan es. 4ecommended she continue to evaluate. She has a physical scheduled with me in February. 4eevaluate at that time. ;nsomnia. Patient was told to try some melatonin over-the-counter and see how this does. A ain, if no improvement, will follow up in February. A3,rme$A*83(#%'9'

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Anu 3ommareddi, 56

)oren B *e""e+ DOB: 0-/30/48 CC: S:

2003426

12/16/13

Followup hypertension, left-sided pain. Patient is a '5-year-old 2aucasian entleman, who presents for evaluation of blood pressure. /e is currently takin 1otrel (#$%# m and 3enicar /20D "#$%5 half a tablet daily and also takin potassium 3# m!E without difficulty. /e reports no chest pain, shortness of breath, or palpitations. /e has had continued pain alon the left side. /e says it is worse if he e)ercises or lifts anythin . /e was accompanyin his dau hter and felt the onset of pain. /e does have a history of small reducible hernias on this side, but symptoms seem to have suddenly worsened. /e is a nonsmoker. Family history is not si nificant for hernia. Patient has a son with history as well of kidney stones and does have blood in urine followed by 6r. 5c2lure for this. +itals, As above. -eneral, >ell-developed, well-nourished male, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. !)tremities, *o edema, cyanosis, or clubbin . !)amination of bilateral roins reveals small reducible hernias. (. 1eft lower abdominal discomfort, likely secondary to small reducible in uinal hernias. Pain is worsened with e)ercise and liftin . /e is referred back to 6r. 6avid Smith at 4alei h Sur ical to further evaluate and mana e. /e may need some mesh placement as he is more symptomatic now. /ypertension, stable. 2ontinue 1otrel and 3enicar /20D. Follow up in three months7 time. /e will check a 25P. A3,rme$A*83(#%'9C

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Anu 3ommareddi, 56

Dar"ene J Da4i# DOB: 0-/02/48 CC: S: Pap and pelvic.

103286!

12/16/13

Patient is a '5-year-old 2aucasian female, who presents today for Pap and pelvic e)am. She is doin self-breast e)am and has not noticed any masses, skin retraction, and dimplin . *o va inal dischar e. She is currently se)ually active. She has had a partial hysterectomy secondary to fibroid. She has been with a partner for the past (# months or so. She is a nonsmoker. +itals, As above. -eneral, !lderly pleasant female, in no acute distress. 3reasts, !)amination of bilateral breasts reveals no obvious masses, nipple dischar e or a)illary lymphadenopathy. -8, !)am reveals normal e)ternal enitalia. 2ervi) is absent. 3imanual e)am was performed, which reveals non-enlar ed uterine and adne)al structures. 4ectal, !)am was performed, which was normal with uaiac ne ative stool. (. %. Pap and pelvic. Patient had SurePath va inal swab Pap completed today. Follow up with her once this is complete. She is recommended to et her mammo ram. 2ontinue self-breast e)am. 5oderate osteopenia on bone density. Patient has options discussed includin bisphosphonate therapy. >e decided to o ahead and start alendronate C# m E. week after side effects and benefits discussed includin risk of esopha itis and osteonecrosis of the <aw. Patient is willin to start takin this. She is to take vitamin 6. She will continue her re ular wei htbearin e)ercise. Follow up with me in one month7s time. A3,rme$A*83(#%'9:

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Anu 3ommareddi, 56

)i0or S %war&5 DOB: 0!/13/82 CC: S: 4i ht-sided pain.

2008442

12/16/13

Patient is a 3(-year-old 2aucasian female who presents today for reevaluation of ri htsided pain that started a few days back alon the posterior ri ht side and then moved forward and it is now alon the ri ht lower Euadrant. She reports no nausea, vomitin , or diarrhea. *o dysuria, urinary ur ency, or freEuency. She reports no history of stones ei&%er in %er#e"' 99999212:283. She is a nonsmoker. Patient reports that she is not near her cycle. She is currently nursin . She has not had any periods since then. 0hey have been usin condoms. +itals, As above. -eneral, ell-developed, well-nourished female, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. Abdomen, Soft, nondistended. 0here is some mild tenderness to palpation alon the ri ht lower Euadrant. *o rebound, uardin , or peritoneal si ns. !)tremities, *o edema, cyanosis, or clubbin . 1abs F urine dip shows %G leukocytes, trace protein. 4i ht lower Euadrant abdominal pain possibly secondary to stone and$or appendicitis or other patholo y. 0he patient is oin to have ri ht lower Euadrant ultrasound to further evaluate. She is recommended to push plenty of fluids. ;f she has any worsenin of symptoms, she is to o to the emer ency room. Follow up with her once ultrasound is complete. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

*aren / Pi&&# DOB: 07/12/62 CC: S: Followup automobile accident.

1040!38

12/16/13

Patient is a 5(-year-old African-American female who was rear-ended as a restrained driver on >ednesday, 6ecember ((th, hit on the left side. She was evaluated at the scene but kept cryin . She took some 0ylenol that evenin and slept and felt better the ne)t day. /owever, then over time, the pain has increased. She says if she oes to reach for somethin , she can barely do it. She has not had any numbness or tin lin down the arms. *o weakness, but si nificant pain alon the neck and upper shoulder. She has not tried takin anythin a ain for the shootin pain that is contributin to her not sleepin well at ni ht. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. 5usculoskeletal !)am, 4eveals limited ran e of motion at cervical spine, forward fle)ion, e)tension, lateral side-to-side bendin . *o tenderness to palpation of the spinous processes. 5otor and sensory e)am of the upper e)tremity is intact. 604s are %G and eEual bilaterally. Positive tenderness to palpation alon the trape&ial muscles bilaterally and paraspinous muscles of the cervical spine. 5usculoskeletal cervical ia pain with trape&ial strain secondary to whiplash type in<ury from car accident on 6ecember ((th. 0he patient is started on some *aprosyn 5## m b.i.d. with food and also recommended cycloben&aprine (# m at bedtime with entle stretchin and heat to the area (5 to %# minutes. Follow up if no improvement, ; would consider P0. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

Anne C )a roi6 DOB: 01/07/67 CC: S: !?- for 5S meds.

200-166

12/16/13

Patient is a "'-year-old 2aucasian female with a history of 5S followed by 6r. Sca nelli, who wants her to start on -ilenya and 0a)otere. She has been on this. She is havin side effects to it. 0his medication apparently has risk of arrhythmia associated with it. Patient has no known history of arrhythmia. She is a nonsmoker. Family history is si nificant for randmother with heart disease. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. !)tremities, *o edema, cyanosis, or clubbin . A (%-lead !?- is obtained, which reveals normal sinus rhythm at a rate of about '# beats per minute. *o S0-0 wave chan es noted. 5S medications with side effects of possible arrhythmia. Patient has normal baseline !?-. She was iven a copy to take with her to the neurolo ist to decide on whether or not -ilenya is an appropriate possible option for her. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

Caro"+n B C%i"&on DOB: 01/27/!CC: S: 6ifficulty sleepin .

201078!

12/16/13

Patient is a 5"-year-old 2aucasian female who presents today to discuss and evaluate difficulty with sleep. She reports that she has a hard time fallin asleep and stayin asleep. She reports feelin an)ious and worried. She and her husband are facin bankruptcy and she is also not makin sales of H'#,### a month for her retail employment at a <ewelry store. She reports no sad mood, cryin spells, suicidal, or homicidal ideations. +itals, As above. -eneral, >ell-developed, well-nourished female, stable mood and affect, normal speech pattern and tone, no psychomotor retardation. 1un s, 20A3. 2+, 444 without 54-. ;nsomnia. After side effects and benefits discussed, the patient is started on tra&odone 5# m one to two tablets at bedtime. She will follow up in one month7s time to reevaluate that, sooner for any worsenin of issues. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

7ara M 78 9er DOB: 04/13/64 CC: S: Followup hypothyroidism.

1043863

12/16/13

Patient is a "B-year-old 2aucasian female, who presents today for reevaluation of hypothyroidism. She is currently takin Armour 0hyroid (%5 mc , takin it without difficulty. She reports no wei ht chan es, constipation, or diarrhea. She unfortunately is (( months and she has had this checked. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. *eck, >ithout thyrome aly. 1un s, 20A3. 2+, 444 without 54-. /ypothyroidism. Patient will have a check of 0S/ and make ad<ustments in Armour 0hyroid accordin ly. Follow up in si) months7 time. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

A0+ E :8#&a4#on DOB: 06/0-/82 CC: S: Followup abdominal pain.

200226-

12/16/13

Patient is a 3(-year-old 2aucasian female treated for repeat Strep for the past several months and switched to 2ipro after she followed up and states symptoms did not feel better. She states that some symptoms have improved, but she still feels lower abdominal pain. She does not have any dysuria, ur ency, or freEuency. *o symptoms of diarrhea or chan es of bowel patterns. She reports no hematuria, fever, or chills. She does have allbladder slud e and had a positive /;6A scan for which she is oin to have elective cholecystectomy done in Ianuary. She reports no nausea or vomitin . She is a nonsmoker. Family history is not si nificant for colon cancer. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. 1un s, 20A3. 2+, 444 without 54-. Abdomen, 5inimal tenderness to palpation alon the suprapubic area. 3imanual e)am is performed, which revealed smooth, nontender, non-enlar ed uterine, adne)al structures. She has very sli ht discomfort alon the lower abdominal area. *o rebound, uardin , or peritoneal si ns. Suprapubic pelvic pain of unclear etiolo y. Patient will have pelvic ultrasound and she has a history of ovarian cyst. >e will follow up with her once this is complete. She will continue her 2ipro 5## m b.i.d. fully. She had noted some mild improvement. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

Saira Ban8 S%ai9 DOB: 12/10/72 CC: S:

2001113

12/16/13

Followup type % diabetes, hypothyroidism, rash. Patient is a "(-year-old ;ndian female, who presents today for reevaluation of above. She has been takin her 1evo)yl :: mc , takin it without difficulty. She reports no constipation. She has had some hair loss, but no fati ue. /er last 0S/ was normal when it was checked back in September at 3.B5#. She reports no polyuria, polypha ia, or polydipsia. She continues to take metformin 5## m b.i.d. She has not been walkin . She has picked up another % pounds. She does have a treadmill at home, but has not been usin it. She states that she has also had a rash below the ri ht breast. ;t has been never before. She has not been usin the *ystatin cream that was iven her before. She reports some mild itchin . She is a nonsmoker. Family history is si nificant for both parents with hypertension. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. *eck, >ithout thyrome aly. 1un s, 20A3. 2+, 444 without 54-. !)tremities, *o edema, cyanosis, or clubbin . Skin, !)am below the ri ht breast is dark and scaly area that appears consistent with candidiasis. (. %. 3. Skin candidiasis. Patient will use *ystatin cream b.i.d. to the area until it is clear. 0ype % diabetes. Patient will have a check of hemo lobin A(c. 2ontinue A6A diet and e)ercise. ; have encoura ed her to et back on her treadmill. She will continue the metformin 5## m b.i.d. She was iven flu shot today as well. /ypothyroidism. Patient will have a check of 0S/ and make ad<ustments to 1evo)yl accordin ly. .therwise, continue :: mc dose. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

Mar e""a B San(er# DOB: 04/20/67 CC: S: Pap and pelvic.

102-77-

12/16/13

Patient is a "'-year-old African-American female who presents today for reevaluation of Pap and pelvic e)am. She is doin self-breast e)am. She has not noticed any masses. She also reports some va inal dischar e, itchin , or concerns about S06s. She had a mammo ram done in February and this was normal. +itals, As above. -eneral, >ell-developed, well-nourished female, in no acute distress. 3reasts, !)amination of the bilateral breasts reveals no obvious masses, skin retractions, or dimplin . *o a)illary lymphadenopathy. -8 !)am, 4eveals normal e)ternal enitalia. 2ervi) is without ross atypia. 3imanual e)am is performed, which reveals smooth, nontender, non-enlar ed uterine and adne)al structures. 4ectal e)am is performed, which reveals normal rectal tone and uaiac ne ative stool. Pap and pelvic. Patient has SurePath Pap completed today. Follow up with her once this is complete. She will continue monthly self breast e)ams and do her mammo ram in February of this year. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56

*ien;9%a0 <n&%i#ane DOB: 03/02/!7 CC: S: 6iscuss bone density.

103-!0!

12/16/13

Patient is a 5'-year-old Asian female who presents today to discuss bone density. /er bone density showed severe osteoporosis alon the lumbar spine of F".%, ri ht hip is F% and left hip was F(.:. She has had (' times increased risk of fracture of the spine based on this number. +itals, As above. distress. -eneral, >ell-developed, well-nourished female, in no acute

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.steoporosis. After side effects and benefits discussed, the patient is recommended to be initiated on Prolia in<ectable '# m subacute E.' month. Side effects includin infection, <aw necrosis, and pancreatitis discussed with the patient. She will be set up for in<ection at rheumatolo y office. Follow up in a year7s time for repeat bone density. She is recommended to take vitamin 6 %### units. She is also to take calcium, re ular wei htbearin e)ercise. A3,pac$A*83(#%'9

Anu 3ommareddi, 56

Mi %ae" P Con'e##ori DOB: 03/13/88 CC: S: Followup an)iety.

2012323

12/16/13

Patient is a %5-year-old 2aucasian male with a history of an)iety since %#((. /e has had worsenin an)iety since his father was killed in a sudden motor vehicle accident at the a e of "B about seven months a o. /e was started on escitalopram (# m about (# days a o secondary to this. /e was feelin a lot of apathy at work and havin a lot of ne ative thou hts. /e had been talkin to his best friend7s father, who is a psychiatrist and had recommended that he consider medications. /e reports some improvement in the apathy and also says he has had less ne ative effects as far as thou hts about father7s death. /e reports improvement in overall an)iety, but still not sure he is fully back to Jnormal.K /e reports no sad mood, cryin spells, suicidal, or homicidal ideation. /e has not had any side effects to the escitalopram. +itals, As above. -eneral, >ell-developed, well-nourished male, stable mood and affect, normal speech pattern and tone, no psychomotor retardation, in no acute distress. An)iety with underlyin depression, improved. Patient will continue escitalopram (# m a day. /e is now to full two to three week therapeutic benefit on this. /e will start continuin to talk to his best friend7s father, the psychiatrist and follow up with me in four to si) weeks time to see how he is feelin . ;f symptoms are persistent, we would consider increasin the dose or tryin an alternative medication. Patient is in a reement. A3,pac$A*83(#%'9

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Anu 3ommareddi, 56