Devin Slickis a 34 y.o.malewho is seen today for Follow-up (Follow up on high cholesterol, referral for previously mentioned skin issues, referral for deviated
septum, referral needed for pediatrician.)

History of Present Illness
Hyperlipidemia
This is achronicproblem. The current episode startedmore than 1 month ago. The problem isuncontrolled. Recent lipid tests were reviewed and arehigh. He has no history ofchronic renal disease,diabetes,hypothyroidism,liver
disease,obesityor nephrotic syndrome. There areno known factorsaggravating his hyperlipidemia. Pertinent negatives include nochest pain,focal sensory loss,focal weakness,leg pain,myalgiasor shortness of breath. Current antihyperlipidemic
treatment includesdiet change and exercise. The current treatment providesmildimprovement of lipids. There areno compliance problems. There areno known risk factorsfor coronary artery disease.

Allergies
Patienthas No Known Allergies.

Medical History
Patienthas a past medical history of Patient denies medical problems.

Surgical History
Patienthas a past surgical history that includes Tonsillectomy and adenoidectomy.

Family History

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

Social History
Patientreports 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.

Review of Systems
Review of Systems
Neurological: Negative for focal weakness.
Respiratory: Negative for shortness of breath.
Cardiovascular: Negative for chest pain.
Musculoskeletal: Negative for myalgias.

Objective:

Objective

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

Body mass index is 30.27 kg/m.

Physical Exam
Constitutional: He appearswell-developedand well-nourished.
HENT:
Head:Normocephalicand atraumatic.
Right Ear:Tympanic membrane,external earand ear canalnormal.
Left Ear:Tympanic membrane,external earand ear canalnormal.
Nose:Nose normal.
Mouth/Throat:Oropharynx is clear and moistand oropharynx normal.Dentition is normal.
Eyes:Pupils are equal, round, and reactive to light.Conjunctivae,EOMand lidsare normal.
Cardiovascular:Normal rate,regular rhythmand normal heart sounds.
Pulmonary/Chest:Effort normaland breath sounds normal.
Psychiatric: He has anormal mood and affect. Hisbehavior is normal.Judgmentand thought contentnormal.
Nursing noteand vitalsreviewed.

.

Assessment & Plan:

Assessment
Mixed hyperlipidemia
Assessment & Plan:
ASSESSMENT:

The patient'shyperlipidemia isunchanged

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 conditionis 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 conditionis new.

PLAN:

Desires screening.

Orders:
- Factor V Assay

Rash
- Dermatology Referral to Sreedevi Kodali, MD (BSWQA, Dermatology, Colleyville)