8\/30\/22, 12:49 PM Print Preview
\n1\/4
\nCurrent Medications
\nTaking
\nDonepezil HCl 10 MG Tablet 1 tablet
\nat bedtime Orally Once a day
\nMeloxicam 7.5 MG Tablet 1 tablet
\nOrally Once a day
\nLosartan Potassium 50 MG Tablet 1
\ntablet Orally Once a day
\nIbandronate Sodium 150 MG Tablet 1
\ntablet Orally Once a month
\nMedication List reviewed and reconciled
\nwith the patient
\nPast Medical History
\nEssential (primary) hypertension.
\nDementia in other diseases classified
\nelsewhere with behavioral disturbance.
\nOther polyosteoarthritis.
\nBed confinement status.
\nDependence on wheelchair.
\nObesity (BMI 30.0-34.9).
\nOsteoporosis without current
\npathological fracture, unspecified
\nosteoporosis type.
\nSurgical History
\nDenies Past Surgical History
\nFamily History
\nFather: deceased
\nMother: deceased
\nSocial History
\nTobacco Use:
\nTobacco Use\/Smoking
\nTobacco use: nonsmoker
\nAllergies
\nN.K.D.A.
\nHospitalization\/Major
\nDiagnostic Procedure
\nDenies Past Hospitalization
\nReview of Systems
\nReason for Appointment
\n1. Initial Assessment
\nHistory of Present Illness
\nExamination:
\n70-year-old female with a past medical history significant for
\ndementia, bed\/wheelchair confinement, hypertension, osteoarthritis,
\nosteoporsis and obesity was seen for an initial examination (telehealth) to
\ndiscuss her chronic medical conditions, evaluate for medical services, and
\ndiscuss remote patient monitoring. Limited subjective assessment due to
\nchronic diagnosis of dementia, medical concerns addressed by daughter.
\nThe patients daughter states that she eats a relatively healthy diet and is
\nminimally physically active throughout the day however does require an
\nHelpive device to ambulate (wheelchair). She complains of occasional
\nbilateral knee pains; however, she states that she is cautious when
\nambulating and has not fallen recently. She currently is under the care of
\nprimary care physician unsure of name also has a caretaker seven days a
\nweek for several hours (approximately 7 hours each day). Her caretaker
\nhelps her get dressed, take care of light housekeeping, Help with general
\nhygiene, prepare food and occasionally go out for short walks. The patients
\ncaretaker states she is taking and tolerating all of her medications as
\nprescribed without any adverse effects. Daughter denies any chest pains,
\npalpitations, shortness of breath, abdominal pain, nausea, vomiting,
\ndiarrhea, constipation, fevers, chills, night sweats, dizziness, acute visual
\nabnormalities, headaches, syncopal episodes, recent known infections,
\nrecent antibiotic use, or any other acute complaints or abnormalities.
\nVital Signs
\nWt 190 lbs, Wt-kg 86.18 kg, Ht 65 in, Ht-cm 165.1 cm, BMI 31.61 Index,
\nBody Surface Area 1.99.
\nExamination
\nGeneral Examination:
\nTeleHealth Visit.
\nPhysical Examination
\nRefer to examination.
\nAssessments
\n1. Essential hypertension – I10 (Primary)
\n2. Primary osteoarthritis involving multiple joints – M89.49
\nDARIUS, YVESROSE DOB: 05\/08\/1951 (70 yo F) Acc No. 24515 DOS: 12\/30\/2021
\nDARIUS, YVESROSE
\n70 Y old Female, DOB: 05\/08\/1951
\nAccount Number: 24515
\n750 OCEAN AVE, APT 1C, BROOKLYN, NY-11226-5308
\nHome: 718-282-4651
\nGuarantor: DARIUS, YVESROSE Insurance: Medicare of New
\nYork Payer ID: NYMRE
\nAppointment Facility: telehealth
\n12\/30\/2021 Progress Notes: Gina M Marotto, PA-C, MPAS
\nProgress Note: Gina M Marotto, PA-C, MPAS 12\/30\/2021
\nNote generated by eClinicalWorks EMR\/PM Software (www.eClinicalWorks.com)
\n8\/30\/22, 12:49 PM Print Preview
\n2\/4
\nGENERAL\/CONSTITUTIONAL:
\nPatient denies change in appetite
\n, chills , fatigue , fever , headache ,
\nlightheadedness , night sweats ,
\nsleep disturbance , weight gain ,
\nweight loss , weakness.
\nRESPIRATORY:
\nPatient denies cough , shortness
\nof breath.
\nCARDIOVASCULAR:
\nPatient denies chest pain ,
\ndizziness , palpitations , shortness
\nof breath , weakness.
\nComments Essential Hypertension.
\nMUSCULOSKELETAL:
\nPatient denies history of gout ,
\nswollen joints, trauma. Patient
\ncomplains of arthritis \/ arthralgia,
\njoint stiffness and pain , painful
\njoints , weakness.
\nNEUROLOGIC:
\nPatient denies dizziness ,
\nfainting. Patient complains of loss of
\nstrength , memory loss.
\n3. Gait abnormality – R26.9
\n4. Counseling and coordination of care – Z71.89
\n5. Dementia in other diseases classified elsewhere with behavioral
\ndisturbance – F02.81
\n6. Dependence on wheelchair – Z99.3
\n7. Obesity (BMI 30.0-34.9) – E66.9
\nTreatment
\n1. Essential hypertension
\nNotes: I reminded the caregiver of the importance of following a
\nDASH diet and monitoring their sodium intake (below 2-3 g per
\nday). The DASH diet consists of fruits, vegetables, whole grains, poultry,
\nand fish while limiting sugars, red meat, and alcohol. In addition, I
\nencouraged the caregiver to monitor blood pressure at least
\nonce per day. Continue current medication(s) as prescribed. Discussed
\nrisks and complications of non compliance with medical recommendations
\nincluding but not limited to myocardial infarction, cerebrovascular
\naccident and death.
\n2. Primary osteoarthritis involving multiple joints
\nNotes: The patient’s complaints are consistent with osteoarthritis, a
\nbreakdown of cartilage from the joints causing the bone to grind on bone. I
\nexplained to the patient that osteoarthritis usually attacks large
\njoints; however, it can also affect smaller joints such as the
\nhand. In addition, painful bone spurs are common with osteoarthritis.
\nRisk factors include age, obesity, female sex, a previous joint injury, and a
\nfamily history of arthritis.Continue current medication as prescribed.
\n3. Counseling and coordination of care
\nNotes: I had an extensive conversation with the patients
\ncaretaker, completing the necessary criteria to bill for CCM \/
\nRPM services. After completing an assessment and CCM care planning, I
\ninitiated CCM services, meeting the comprehensive assessment and care
\nplanning requirements. I discussed the availability of CCM services in
\napplicable call sharing. I made it clear that only one practitioner could
\nfurnish and be paid for CCM services during a calendar month. The patient
\nhas the right to stop CCM services at any time. Lastly, I offered remote
\npatient monitoring services, which I explained would help us
\nmanage the patient remotely. Our care managers will report any
\nabnormalities within a reasonable amount of time. Based on the patient’s
\nvalues, I will discuss if further intervention is needed. CCM goals and
\nexpected outcomes: 1) Tight glycemic control with a hemoglobin A1c less
\nthan 6.5 (American Diabetes Association), 2) Blood pressure control with a
\ntarget reading below 130\/80 (American Heart Association), 3) Vitamin D
\nlevel greater than 30, 4) LDL below 70, triglycerides below 150, 5) Weight
\nreduction, 6) Remaining up to date with immunizations including flu,
\npneumococcal, Tdap, shingles, COVID-19, and Hepatitis. The patient’s
\nchronic conditions are stable, and with continued monitoring
\nand encouragement, the goals set forth are achievable
\nA) The patient requires frequent reminders and reinforcements
\nto achieve the goals we set forth, hopefully optimizing their
\ngeneral health as best as possible. B) I discussed the care plan with
\nthe patient’s nurse, aide, and other providers. C) I advised that we
\nregularly monitor the patient’s blood pressures and establish a trend to
\nDARIUS, YVESROSE DOB: 05\/08\/1951 (70 yo F) Acc No. 24515 DOS: 12\/30\/2021
\nProgress Note: Gina M Marotto, PA-C, MPAS 12\/30\/2021
\nNote generated by eClinicalWorks EMR\/PM Software (www.eClinicalWorks.com)
\n8\/30\/22, 12:49 PM Print Preview
\n3\/4
\nascertain efficacy and stability. D) Routine lab work. E) Continued
\nencouragement, nutritional counseling, and adherence to lifestyle
\nmodifications, mainly targeting obesity. F) I hope that the patients
\ncaretaker will continue to follow the above recommendations.
\nHowever, the prognosis is dependent on the patient’s
\nintervention and cooperation with the above guidelines.
\n4. Dementia in other diseases classified elsewhere with
\nbehavioral disturbance
\nClinical Notes: Reiterated importance of medication compliance, routine
\nfollow up with neurology, implementation of reorientation exercises and
\nverbal communication to slow progression and exacerbation of symptoms.
\nDiscussed risks and complications of non compliance with medical
\nrecommendations including but not limited to failure to thrive and death.
\n5. Dependence on wheelchair
\nClinical Notes: Hospital bed requested, prescribed. Reiterated importance
\nof repositioning and implementation of supportive medical equipment
\nincluding but not limited to wheelchair cushion and hospital bed to
\ndecrease risk of skin breakdown\/skin ulcerations. Fall risk assessment
\ncompleted, patient is a high fall risk. Reiterated importance of ambulating
\nwith Helpive device for support and to decrease risk of falls. Discussed
\nrisks and complications of non compliance with medical recommendations
\nincluding but not limited to fracture, hemorrhage, deep venous
\nthrombosis, respiratory failure, osteomyelitis, sepsis and death.
\n6. Obesity (BMI 30.0-34.9)
\nClinical Notes: Reiterated importance of continued implementation of diet
\nmodification. Avoid foods with high fat content to decrease risk of
\npotential complications and risks including but not limited to myocardial
\ninfarction, cerebrovascular accident and death.
\nProcedure Codes
\nG0447 FCE-FCE BEHAVRL CNSL OBESITY 15 MIN
\n99443 PHONE E\/M BY PHYS 21-30 MIN
\nG8427 DOC MEDS VERIFIED W\/PT OR RE
\n0518F FALL PLAN OF CARE DOCD
\n3288F FALL RISK ASSESSMENT DOCD
\nG8938 BMI CALC BUT PT NOT ELIG F\/U PLAN
\nFollow Up
\n2 Weeks (Reason: wheelchair dependence)
\nElectronically signed by Gina Marotto , PA-C,MPAS on
\n12\/30\/2021 at 03:37 PM EST
\nSign off status: Completed
\nDARIUS, YVESROSE DOB: 05\/08\/1951 (70 yo F) Acc No. 24515 DOS: 12\/30\/2021
\nProgress Note: Gina M Marotto, PA-C, MPAS 12\/30\/2021
\nNote generated by eClinicalWorks EMR\/PM Software (www.eClinicalWorks.com)
\n8\/30\/22, 12:49 PM Print Preview
\n4\/4
\ntelehealth
\n1573 E 22ND ST
\nBROOKLYN, NY 11210-5109
\nTel: 646-919-0757
\nFax:
\nDARIUS, YVESROSE DOB: 05\/08\/1951 (70 yo F) Acc No. 24515 DOS: 12\/30\/2021
\nProgress Note: Gina M Marotto, PA-C, MPAS 12\/30\/2021
\nNote generated by eClinicalWorks EMR\/PM Software (www.eClinicalWorks.com)<\/p>\n","protected":false},"excerpt":{"rendered":"
8\/30\/22, 12:49 PM Print Preview 1\/4 Current Medications Taking Donepezil HCl 10 MG Tablet 1 tablet at bedtime Orally Once a day Meloxicam 7.5 MG\u2026<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7695,1463,7667,7669,7684,7696,7683,7657,7663,7662,7685,7694,2751,7665,7664,1468,7666,7659,7660,7661,7658,1465],"tags":[642,618,8825,576,116,631,19,643,473,633,630,628,450,597,594,626,635,574,622,624,620,621,619,623,617,625,627,634,629,632,644,645,42,66],"class_list":["post-93852","post","type-post","status-publish","format-standard","hentry","category-assignment-essay-help","category-best-nursing-paper-writing-service","category-buy-bsn-nursing-papers-online","category-buy-dnp-nursing-papers-online","category-dream-assignment-help","category-essay-writing-service-help","category-go-assignment-help","category-healthcare-management-assignment-help-from-experts","category-help-my-assignment","category-ireland-assignment-help","category-my-assignment-help","category-my-essay-assignment-help","category-online-healthcare-assignment-help","category-online-nursing-essay","category-online-nursing-paper-writers","category-online-nursing-papers","category-online-public-healthcare-assignment-help","category-online-tutors-helps","category-sample-assignment","category-top-essay-writing","category-urgent-assignment-helper","category-write-my-nursing-paper","tag-apps-that-write-essays-for-you-free","tag-assignment-writing-services-in-usa","tag-bes","tag-best-dissertation-writing-services","tag-best-essay-writing-service","tag-best-paper-writing-services","tag-best-research-paper-writing-services-in-usa","tag-best-website-to-write-my-essay","tag-cheap-essay-writing-service","tag-cheap-research-paper-writing-service","tag-college-paper-writing-service","tag-dissertation-help-online","tag-dissertation-writing-services","tag-dissertation-writing-services-illegal","tag-dissertation-writing-services-near-me","tag-dissertation-writing-services-usa","tag-essay-writing-service","tag-free-dissertation-writing-services","tag-homework-essay-writer","tag-homework-essay-writer-free","tag-homework-help-global","tag-homework-help-services","tag-homework-help-usa","tag-homework-writing-help","tag-homework-writing-service","tag-legit-research-paper-writing-services","tag-legitimate-dissertation-writing-services","tag-research-paper-writer-online-free","tag-research-paper-writing-services-online","tag-research-paper-writing-websites","tag-write-my-essay-for-me-cheap","tag-write-my-essay-for-me-tik-tok","tag-write-my-essay-free","tag-write-my-paper"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/93852","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=93852"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/93852\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=93852"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=93852"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=93852"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}