Subjective: SUBJNOHEADERBEGIN|1|||0||MR_COMSUM^``^#`BEGIN^``^#`Subjective^``^#`2^``^#`390562.254057^``^#`0^``^#`1^``^#`MR_COMSUM^``^#`BEGIN^``^#`Subjective^``^#`2^``^#`390562.254057^``^#`0^``^#`1^``^#` SECTION_BOOKMARK_END^``^#`MR_COMSUM^``^#`BEGIN^``^#`Subjective^``^#`2^``^#`390562.254057^``^#`0^``^#`1^``^#`SECTION_BOOKMARK_END^``^#`MR_COMSUM^``^#`BEGIN^``^#`Subjective^``^#`2^``^#`390562.254057^``^#`0^``^#`1^``^#` SUBJNOHEADERBEGIN|1|||0||NAME|0|||0||Devin SlickNAME|0|||0||is a AGE|0|||0||34 y.o.AGE|0|||0||SEX|0|||0||maleSEX|0|||0||who is seen today for CCN|1|||0||Follow-up (Follow up on high cholesterol, referral for previously mentioned skin issues, referral for deviated septum, referral needed for pediatrician.) CCN|1|||0||History of Present Illness BLOCKBEGIN|SFHPI|BLOCKBEGIN|SFHPI|49000__49156_BEGIN49000__49156_BEGIN49000__49156_END49000__49156_END60400_EPIC#5266_49022_BEGIN60400_EPIC#5266_49022_BEGINHyperlipidemia 60400_EPIC#5266_49022_END60400_EPIC#5266_49022_END60400_EPIC#5266_60435_BEGIN60400_EPIC#5266_60435_BEGIN60400_EPIC#5266_60435_END60400_EPIC#5266_60435_END 60400_EPIC#5266_62022_BEGIN60400_EPIC#5266_62022_BEGINThis is a chronic problem. 60400_EPIC#5266_62022_END 60400_EPIC#5266_62022_END60400_EPIC#5266_60664_BEGIN60400_EPIC#5266_60664_BEGINThe current episode started more than 1 month ago. 60400_EPIC#5266_60664_END60400_EPIC#5266_60664_END 60400_EPIC#5266_60438_BEGIN60400_EPIC#5266_60438_BEGINThe problem is uncontrolled. 60400_EPIC#5266_60438_END60400_EPIC#5266_60438_END60400_EPIC#5266_60450_BEGIN60400_EPIC#5266_60450_BEGINRecent lipid tests were reviewed and are high. 60400_EPIC#5266_60450_END60400_EPIC#5266_60450_END60400_EPIC#5266_60441_BEGIN60400_EPIC#5266_60441_BEGINHe has no history of chronic renal disease, diabetes, hypothyroidism, liver disease, obesity or nephrotic syndrome. 60400_EPIC#5266_60441_END60400_EPIC#5266_60441_END60400_EPIC#5266_60444_BEGIN60400_EPIC#5266_60444_BEGIN60400_EPIC#5266_60444_END 60400_EPIC#5266_60444_END60400_EPIC#5266_60670_BEGIN60400_EPIC#5266_60670_BEGINThere are no known factors aggravating his hyperlipidemia. 60400_EPIC#5266_60670_END60400_EPIC#5266_60670_END 60400_EPIC#5266_60447_BEGIN60400_EPIC#5266_60447_BEGINPertinent negatives include no chest pain, focal sensory loss, focal weakness, leg pain, myalgias or shortness of breath. 60400_EPIC#5266_60447_END60400_EPIC#5266_60447_END 60400_EPIC#5266_62021_BEGIN60400_EPIC#5266_62021_BEGIN60400_EPIC#5266_62021_END60400_EPIC#5266_62021_END60400_EPIC#5266_60679_BEGIN60400_EPIC#5266_60679_BEGINCurrent antihyperlipidemic treatment includes diet change and exercise. 60400_EPIC#5266_60679_END60400_EPIC#5266_60679_END60400_EPIC#5266_60688_BEGIN60400_EPIC#5266_60688_BEGINThe current treatment provides mild improvement of lipids. 60400_EPIC#5266_60688_END60400_EPIC#5266_60688_END60400_EPIC#5266_60551_BEGIN60400_EPIC#5266_60551_BEGINThere are no compliance problems. 60400_EPIC#5266_60551_END 60400_EPIC#5266_60551_END60400_EPIC#5266_210520_BEGIN60400_EPIC#5266_210520_BEGINThere are no known risk factors for coronary artery disease. 60400_EPIC#5266_210520_END60400_EPIC#5266_210520_END BLOCKEND|SFHPI|BLOCKEND|SFHPI|Allergies Patient ALGP|1|||0||has No Known Allergies.ALGP|1|||0|| Medical History Patient PMHPNN|1|||0|| has a past medical history of Patient denies medical problems. PMHPNN|1|||0||Surgical History Patient PSHP|1|||0||has a past surgical history that includes Tonsillectomy and adenoidectomy. PSHP|1|||0||" Family History FAMHX|1|||0||Family History Problem Relation Age of Onset ? Hypertension Mother ? Factor V Leiden deficiency Mother ? Diabetes Father ? Factor V Leiden deficiency Sister ? Factor V Leiden deficiency Brother FAMHX|1|||0||Social History Patient SOCHXP|1|||0||reports that he has never smoked. He has never been exposed to tobacco smoke. He has never used smokeless tobacco. He reports current alcohol use of about 2.5 standard drinks per week. He reports that he does not use drugs.SOCHXP|1|||0||Review of Systems BLOCKBEGIN|HTPNROSBYAGE|BLOCKBEGIN|HTPNROSBYAGE|1000423__75002_BEGIN1000423__75002_BEGIN1000423__75002_END1000423__75002_END1000423__1000431_BEGIN1000423__1000431_BEGIN 1000423__1000431_END1000423__1000431_END1000423__75641_BEGIN1000423__75641_BEGIN1000423__75641_END1000423__75641_END1000423__1016313_BEGIN1000423__1016313_BEGIN 1000423__1016313_END1000423__1016313_END1000423__1016315_BEGIN1000423__1016315_BEGIN1000423__1016315_END1000423__1016315_END1000423__1000461_BEGIN1000423__1000461_BEGIN 1000423__1000461_END1000423__1000461_END1000423__1000427_BEGIN1000423__1000427_BEGIN1000423__1000427_END1000423__1000427_END1000423__1016321_BEGIN1000423__1016321_BEGIN 1000423__1016321_END1000423__1016321_ENDReview of Systems 1000423__1000459_BEGIN1000423__1000459_BEGIN Neurological: Negative for focal weakness. 1000423__1000459_END1000423__1000459_END1000423__1016317_BEGIN1000423__1016317_BEGIN Respiratory: Negative for shortness of breath. 1000423__1016317_END1000423__1016317_END1000423__1016323_BEGIN1000423__1016323_BEGIN Cardiovascular: Negative for chest pain. 1000423__1016323_END1000423__1016323_END1000423__1000429_BEGIN1000423__1000429_BEGIN1000423__1000429_END1000423__1000429_END 1000423__1016319_BEGIN1000423__1016319_BEGIN Musculoskeletal: Negative for myalgias. 1000423__1016319_END1000423__1016319_END1000423__1016326_BEGIN1000423__1016326_BEGIN1000423__1016326_END1000423__1016326_END 1000423__1000433_BEGIN1000423__1000433_BEGIN1000423__1000433_END1000423__1000433_END1000423__1000424_BEGIN1000423__1000424_BEGIN1000423__1000424_END1000423__1000424_END BLOCKEND|HTPNROSBYAGE|BLOCKEND|HTPNROSBYAGE|SUBJECTIVEEND|1|||0||MR_COMSUM^``^#`END^``^#`Subjective^``^#`0^``^#`390562.264896^``^#`0^``^#`1^``^#`MR_COMSUM^``^#`END^``^#`Subjective^``^#`0^``^#`390562.264896^``^#`0^``^#`1^``^#` SUBJECTIVEEND|1|||0||Objective: OBJNOHEADERBEGIN|1|||0||MR_COMSUM^``^#`BEGIN^``^#`Objective^``^#`2^``^#`390562.266263^``^#`0^``^#`2^``^#`MR_COMSUM^``^#`BEGIN^``^#`Objective^``^#`2^``^#`390562.266263^``^#`0^``^#`2^``^#` SECTION_BOOKMARK_END^``^#`MR_COMSUM^``^#`BEGIN^``^#`Objective^``^#`2^``^#`390562.266263^``^#`0^``^#`2^``^#`SECTION_BOOKMARK_END^``^#`MR_COMSUM^``^#`BEGIN^``^#`Objective^``^#`2^``^#`390562.266263^``^#`0^``^#`2^``^#` OBJNOHEADERBEGIN|1|||0||VITALSFULL|1|||0|| Vitals Recorded in This Encounter 4/19/2023 1332 BP: 132/88 Pulse: 68 Resp: 18 Temp: 97.9 F (36.6 C) Temp src: Temporal Weight: 98.4 kg (217 lb) Height: 180.3 cm (71") BMI (Calculated): 30.3 Pain Score: Zero Pain Edu?: N Cuff size: Adt BP Location: Left Arm VITALSFULL|1|||0||BMI|1|||0||Body mass index is 30.27 kg/m.BMI|1|||0||BLOCKBEGIN|HTPNPHYEXAMBYAGE|BLOCKBEGIN|HTPNPHYEXAMBYAGE|Physical Exam 1011192__1011193_BEGIN1011192__1011193_BEGIN Constitutional: He appears well-developed and well-nourished. 1011192__1011193_END1011192__1011193_END1011192__1000446_BEGIN1011192__1000446_BEGIN HENT: Head: Normocephalic and atraumatic. Right Ear: Tympanic membrane, external ear and ear canal normal. Left Ear: Tympanic membrane, external ear and ear canal normal. Nose: Nose normal. Mouth/Throat: Oropharynx is clear and moist and oropharynx normal. Dentition is normal. 1011192__1000446_END 1011192__1000446_END1011192__75105_BEGIN1011192__75105_BEGIN Eyes: Pupils are equal, round, and reactive to light. Conjunctivae, EOM and lids are normal. 1011192__75105_END1011192__75105_END1011192__1016336_BEGIN1011192__1016336_BEGIN1011192__1016336_END 1011192__1016336_END1011192__1000604_BEGIN1011192__1000604_BEGIN Cardiovascular: Normal rate, regular rhythm and normal heart sounds. 1011192__1000604_END1011192__1000604_END1011192__1017310_BEGIN1011192__1017310_BEGIN Pulmonary/Chest: Effort normal and breath sounds normal. 1011192__1017310_END1011192__1017310_END1011192__1018171_BEGIN1011192__1018171_BEGIN1011192__1018171_END1011192__1018171_END 1011192__1000417_BEGIN1011192__1000417_BEGIN1011192__1000417_END1011192__1000417_END1011192__1011198_BEGIN1011192__1011198_BEGIN1011192__1011198_END1011192__1011198_END 1011192__1000235_BEGIN1011192__1000235_BEGIN1011192__1000235_END1011192__1000235_END1011192__75383_BEGIN1011192__75383_BEGIN1011192__75383_END1011192__75383_END 1011192__1018174_BEGIN1011192__1018174_BEGIN1011192__1018174_END1011192__1018174_END1011192__1000420_BEGIN1011192__1000420_BEGIN1011192__1000420_END1011192__1000420_END 1011192__75442_BEGIN1011192__75442_BEGIN Psychiatric: He has a normal mood and affect. His behavior is normal. Judgment and thought content normal. 1011192__75442_END1011192__75442_END1011192__75063_BEGIN1011192__75063_BEGIN Nursing note and vitals reviewed.1011192__75063_END1011192__75063_END BLOCKEND|HTPNPHYEXAMBYAGE|BLOCKEND|HTPNPHYEXAMBYAGE|BLOCKBEGIN|ASTHMAP2|BLOCKBEGIN|ASTHMAP2|.BLOCKEND|ASTHMAP2|BLOCKEND|ASTHMAP2|OBJECTIVEEND|1|||0||MR_COMSUM^``^#`END^``^#`Objective^``^#`0^``^#`390562.306679^``^#`0^``^#`2^``^#`MR_COMSUM^``^#`END^``^#`Objective^``^#`0^``^#`390562.306679^``^#`0^``^#`2^``^#` OBJECTIVEEND|1|||0||" Assessment & Plan: ASSESSNOHEADERBEGIN|1|||0||MR_COMSUM^``^#`BEGIN^``^#`Assessment^``^#`2^``^#`390562.307923^``^#`0^``^#`3^``^#`MR_COMSUM^``^#`BEGIN^``^#`Assessment^``^#`2^``^#`390562.307923^``^#`0^``^#`3^``^#` SECTION_BOOKMARK_END^``^#`MR_COMSUM^``^#`BEGIN^``^#`Assessment^``^#`2^``^#`390562.307923^``^#`0^``^#`3^``^#`SECTION_BOOKMARK_END^``^#`MR_COMSUM^``^#`BEGIN^``^#`Assessment^``^#`2^``^#`390562.307923^``^#`0^``^#`3^``^#` ASSESSNOHEADERBEGIN|1|||0||ASSESSPLAN1|1|||0||Mixed hyperlipidemia Assessment & Plan: ASSESSMENT: The patient's hyperlipidemia is unchanged Diagnostics Reviewed: BP Readings from Last 3 Encounters: 04/19/23 132/88 01/06/23 120/84 The ASCVD Risk score (Arnett DK, et al., 2019) failed to calculate for the following reasons: The 2019 ASCVD risk score is only valid for ages 40 to 79 PLAN: Discussed lifestyle changes. Will recheck in three months. Orders: - Lipid Panel; Future Deviated septum Assessment & Plan: ASSESSMENT: The patient's condition is unchanged . PLAN: Patient with history of nasal fracture. Would like to see ENT. Will send to Dr Ducic. Orders: - Amb Referral to ENT Family history of factor V deficiency Assessment & Plan: ASSESSMENT: The patient's condition is new . PLAN: Desires screening. Orders: - Factor V Assay Rash - Dermatology Referral to Sreedevi Kodali, MD (BSWQA, Dermatology, Colleyville) ASSESSPLAN1|1|||0||