diff --git a/.github/workflows/medcat-scripts_main.yml b/.github/workflows/medcat-scripts_main.yml
new file mode 100644
index 00000000..b73a90ac
--- /dev/null
+++ b/.github/workflows/medcat-scripts_main.yml
@@ -0,0 +1,57 @@
+name: medcat-scripts - Test
+
+on:
+  push:
+    branches: [ main ]
+  pull_request:
+    paths:
+      - 'medcat-scripts/**'
+      - '.github/workflows/medcat-scripts**'
+
+defaults:
+  run:
+    working-directory: ./medcat-scripts
+
+jobs:
+  build:
+    runs-on: ubuntu-latest
+    strategy:
+      matrix:
+        python-version: [ '3.9', '3.10', '3.11', '3.12' ]
+      max-parallel: 4
+    steps:
+      - uses: actions/checkout@v5
+      - name: Install uv for Python ${{ matrix.python-version }}
+        uses: astral-sh/setup-uv@v6
+        with:
+          python-version: ${{ matrix.python-version }}
+          enable-cache: true
+      - name: Install the project
+        run: |
+          uv venv .venv
+          source .venv/bin/activate
+          uv run python -m ensurepip
+          uv pip install -r requirements.txt
+          uv pip install -r requirements-dev.txt
+      - name: Check types
+        run: |
+          # NOTE: Only testing against .py files in this folder
+          uv run python -m mypy `git ls-tree --full-tree --name-only -r HEAD | grep ".py$" | grep "^medcat-scripts" | grep -v "tests/" | sed 's|^medcat-scripts/||'` --explicit-package-bases --follow-imports=normal
+
+      - name: Setup for notebook tests
+        run: |
+          # NOTE: this will make sure there's something in the den to work with below
+          uv run python tests/setup_for_tests.py
+
+      - name: Install IPython kernel
+        run: |
+          uv run python -m ipykernel install --name smoketests --user
+
+      - name: Run tests
+        run: |
+          uv run pytest tests
+
+      - name: Test notebooks
+        run: |
+          uv run pytest --collect-only --nbmake **/*.ipynb
+          uv run pytest --nbmake -n=auto --nbmake-kernel=smoketests --nbmake-timeout=1800 **/*.ipynb
\ No newline at end of file
diff --git a/medcat-scripts/data/mct_exports/example_mct_export.json b/medcat-scripts/data/mct_exports/example_mct_export.json
new file mode 100644
index 00000000..e8d4440f
--- /dev/null
+++ b/medcat-scripts/data/mct_exports/example_mct_export.json
@@ -0,0 +1 @@
+{"projects": [{"name": "MT Samples (Clone)", "id": 14, "cuis": "", "tuis": "T047,T048", "documents": [{"id": 3204, "name": "1687", "text": "SUBJECTIVE: , The patient is a 60-year-old female, who complained of coughing during meals.  Her outpatient evaluation revealed a mild-to-moderate cognitive linguistic deficit, which was completed approximately 2 months ago.  The patient had a history of hypertension and TIA/stroke.  The patient denied history of heartburn and/or gastroesophageal reflux disorder.  A modified barium swallow study was ordered to objectively evaluate the patient's swallowing function and safety and to rule out aspiration.,OBJECTIVE: , Modified barium swallow study was performed in the Radiology Suite in cooperation with Dr. ABC.  The patient was seated upright in a video imaging chair throughout this assessment.  To evaluate the patient's swallowing function and safety, she was administered graduated amounts of liquid and food mixed with barium in the form of thin liquid (teaspoon x2, cup sip x2); nectar-thick liquid (teaspoon x2, cup sip x2); puree consistency (teaspoon x2); and solid food consistency (1/4 cracker x1).,ASSESSMENT,ORAL STAGE:,  Premature spillage to the level of the valleculae and pyriform sinuses with thin liquid.  Decreased tongue base retraction, which contributed to vallecular pooling after the swallow.,PHARYNGEAL STAGE: , No aspiration was observed during this evaluation.  Penetration was noted with cup sips of thin liquid only.  Trace residual on the valleculae and on tongue base with nectar-thick puree and solid consistencies.  The patient's hyolaryngeal elevation and anterior movement are within functional limits.  Epiglottic inversion is within functional limits.,CERVICAL ESOPHAGEAL STAGE:  ,The patient's upper esophageal sphincter opening is well coordinated with swallow and readily accepted the bolus.  Radiologist noted reduced peristaltic action of the constricted muscles in the esophagus, which may be contributing to the patient's complaint of globus sensation.,DIAGNOSTIC IMPRESSION:,  No aspiration was noted during this evaluation.  Penetration with cup sips of thin liquid.  The patient did cough during this evaluation, but that was noted related to aspiration or penetration.,PROGNOSTIC IMPRESSION: ,Based on this evaluation, the prognosis for swallowing and safety is good.,PLAN: , Based on this evaluation and following recommendations are being made:,1.  The patient to take small bite and small sips to help decrease the risk of aspiration and penetration.,2.  The patient should remain upright at a 90-degree angle for at least 45 minutes after meals to decrease the risk of aspiration and penetration as well as to reduce her globus sensation.,3.  The patient should be referred to a gastroenterologist for further evaluation of her esophageal function.,The patient does not need any skilled speech therapy for her swallowing abilities at this time, and she is discharged from my services.", "last_modified": "2020-03-29 14:43:25.537525+00:00", "annotations": [{"id": 45580, "user": "wish", "cui": "C0017168", "value": "gastroesophageal reflux", "start": 332, "end": 355, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:06:34.303633+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45581, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 255, "end": 267, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:06:30.394941+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45582, "user": "wish", "cui": "C0012634", "value": "disorder", "start": 356, "end": 364, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:06:48.174475+00:00", "manually_created": false, "acc": 0.364258020093567, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45583, "user": "wish", "cui": "C0038454", "value": "stroke", "start": 276, "end": 282, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:06:33.410261+00:00", "manually_created": false, "acc": 0.39498916376357734, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45584, "user": "wish", "cui": "C0007787", "value": "TIA", "start": 272, "end": 275, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:06:32.727096+00:00", "manually_created": false, "acc": 0.43553226241827225, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3205, "name": "1605", "text": "CHIEF COMPLAINT: , Chest pain and fever.,HISTORY OF PRESENT ILLNESS: , This 48-year-old white married female presents in the emergency room after two days of increasing fever with recent diagnosis of urinary tract infection on outpatient treatment with nitrofurantoin.  The patient noted since she began to feel poorly earlier on the day of admission, had an episode of substernal chest discomfort that was associated with nausea, dizziness, and sweating.  The patient does have a past medical history of diabetes and hypertension.  In addition, the patient complained of some neck and head discomfort for which she underwent a lumbar puncture in the emergency room; this was normal, causes turned out to be normal as well.  The patient denies nosebleed, visual changes, nausea, vomiting, diarrhea or changes in bowel habits.  She has not had any musculoskeletal or neurological deficits.  She denies any rashes or skin lesions.,PAST MEDICAL HISTORY:  ,Hypertension, diabetes, hyperlipidemia, particularly elevated triglycerides with a slightly elevated LDL at 81 with an new standard LDL of 74, diabetics with a bad family history for cardiovascular disease such as this patient does have, and postmenopausal hot flashes.,PAST SURGICAL HISTORY:  ,Cholecystectomy, appendectomy, oophorectomy.,FAMILY HISTORY: , Positive for coronary artery disease in her father and brother in their 40s.,SOCIAL HISTORY: , She is married and does not smoke or drink nor did she ever.,PHYSICAL EXAMINATION: , On admission, temperature 99.4 degrees F., blood pressure 137/60, pulse 90 and regular without ectopy, respiratory rate 20 without unusual respiratory effort.  In general, she is well developed, well nourished, oriented, and alert and in no apparent distress.  Head, ears, eyes, nose, and throat are unremarkable.  Neck is supple.  No neck vein distention is noted.  No bruits are heard.  Chest is clear to percussion and auscultation.  Heart has a regular rhythm and rate without murmurs or rubs or gallops.  Abdomen is soft, obese, and nontender.  Musculoskeletal is intact without deformity.  However, the patient did develop severe cramp behind her left knee during her treadmill testing.  Neurologic:  Cranial nerves are intact and she is nonfocal.  Skin is warm and dry without rash or lesions noted.,LABORATORY FINDINGS: , Glucose 162, BUN 14, creatinine 1.0, sodium 137, potassium 3.6, chloride 103, bicarbonate 23, protein 4.2.  Liver function panel is normal.  CK was 82.  MB fraction was 1.0.  Troponin was less than 0.1 on three occasions.  White count was 12,200 with a normal differential, hemoglobin was 12.1, platelet count 230,000.  Urinalysis showed positive nitrites, positive leukocyte esterase, 5 to 10 white cells per high power field, and 1+ bacteria rods.  Spinal fluid was clear with 11 red cells, glucose 75, protein 67, white count 0.  EKG was normal.,DIAGNOSES ON ADMISSION:,1.  Urinary tract infection.,2.  Chest pain of unclear etiology, rule out myocardial infarction.,3.  Neck and back pain of unclear etiology with a negative spinal tap.,4.  Hypertension.,5.  Diabetes type II, not treated with insulin.,6.  Hyperlipidemia treated with TriCor but not statins.,7.  Arthritis.,ADDITIONAL LABORATORY STUDIES:,  B-natriuretic peptide was 26.  Urine smear and culture negative on 24 and 48 hours.  Chest x-ray was negative.  Lipid panel - triglycerides 249, VLDL 49, HDL 33, LDL 81.,COURSE IN THE HOSPITAL: , The patient was placed on home medications.  This will be listed at the end of the discharge summary.  She was put on rule out acute myocardial infarction routine, and she did in fact rule out.  She had a stress test completed on the day of discharge which was normal, and she was discharged with a diagnoses of chest pain, acute myocardial infarction ruled out, urinary tract infection, fever secondary to UTI, diabetes mellitus type 2 non-insulin treated, hyperlipidemia with elevated triglycerides and an LDL elevated to 81 with new normal being less than 70.  She has a strong family history of early myocardial disease in the men in their 40s.,DISCHARGE MEDICATIONS:,1.  Enteric-coated aspirin 81 mg one daily.  This is new, as the patient was not taking aspirin at home.,2.  TriCor 48 mg one daily.,3.  Zantac 40 mg one daily.,4.  Lisinopril 20 mg one daily.,5.  Mobic 75 mg one daily for arthritis.,6.  Metformin 500 mg one daily.,7.  Macrodantin one two times a day for several more days.,8.  Zocor 20 mg one daily, which is a new addition.,9.  Effexor XR 37.5 mg one daily.,DIET: , ADA 1800-calorie diet.,ACTIVITY:,  As tolerated.  Continue water exercise five days a week.,DISPOSITION: , Recheck at Hospital with a regular physician there in 1 week.  Consider Byetta as an adjunct to her diabetic treatment and efforts to weight control.", "last_modified": "2020-03-29 14:43:25.538333+00:00", "annotations": [{"id": 45585, "user": "wish", "cui": "C0155626", "value": "acute myocardial infarction", "start": 3555, "end": 3582, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:02.455949+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45586, "user": "wish", "cui": "C0155626", "value": "acute myocardial infarction", "start": 3752, "end": 3779, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:05.459069+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45587, "user": "wish", "cui": "C0011860", "value": "diabetes mellitus type 2", "start": 3840, "end": 3864, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:10.676220+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45588, "user": "wish", "cui": "C0042029", "value": "urinary tract infection", "start": 200, "end": 223, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:06:57.312323+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45589, "user": "wish", "cui": "C0042029", "value": "Urinary tract infection", "start": 2898, "end": 2921, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:51.028108+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45590, "user": "wish", "cui": "C0042029", "value": "urinary tract infection", "start": 3791, "end": 3814, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:08.633594+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45591, "user": "wish", "cui": "C0010068", "value": "coronary artery disease", "start": 1324, "end": 1347, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:39.702986+00:00", "manually_created": false, "acc": 0.5504322799558069, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45592, "user": "wish", "cui": "C0007222", "value": "cardiovascular disease", "start": 1136, "end": 1158, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:36.229587+00:00", "manually_created": false, "acc": 0.558904164365694, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45593, "user": "wish", "cui": "C0027051", "value": "myocardial infarction", "start": 2968, "end": 2989, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:53.183209+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45594, "user": "wish", "cui": "C0878544", "value": "myocardial disease", "start": 4033, "end": 4051, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:13.396193+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45595, "user": "wish", "cui": "C0011860", "value": "Diabetes type II", "start": 3084, "end": 3100, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:57.136409+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45596, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 977, "end": 991, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:35.202838+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45597, "user": "wish", "cui": "C0020473", "value": "Hyperlipidemia", "start": 3132, "end": 3146, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:58.301306+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45598, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 3886, "end": 3900, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:11.504493+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45599, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 518, "end": 530, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:19.824713+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}, {"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45600, "user": "wish", "cui": "C0037284", "value": "skin lesions", "start": 915, "end": 927, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:30.761228+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45601, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 953, "end": 965, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:31.752120+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45602, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 3066, "end": 3078, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:55.539090+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45603, "user": "wish", "cui": "C0003864", "value": "Arthritis", "start": 3188, "end": 3197, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:01.409098+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45604, "user": "wish", "cui": "C0003864", "value": "arthritis", "start": 4323, "end": 4332, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:17.017254+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45605, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 505, "end": 513, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:10.971059+00:00", "manually_created": false, "acc": 0.6018078580960269, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45606, "user": "wish", "cui": "C0011849", "value": "diabetes", "start": 967, "end": 975, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:34.520090+00:00", "manually_created": false, "acc": 0.6011015540328982, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45607, "user": "wish", "cui": "C0338614", "value": "episode", "start": 359, "end": 366, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:07:08.797248+00:00", "manually_created": false, "acc": 0.4721907772509702, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45608, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2283, "end": 2290, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:07:42.009112+00:00", "manually_created": false, "acc": 0.4283007394246088, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45609, "user": "wish", "cui": "C0042029", "value": "UTI", "start": 3835, "end": 3838, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:09.822242+00:00", "manually_created": false, "acc": 0.46978565675753237, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3206, "name": "466", "text": "HISTORY OF PRESENT ILLNESS: , The patient is a 45-year-old male complaining of abdominal pain.  The patient also has a long-standing history of diabetes which is treated with Micronase daily.,PAST MEDICAL HISTORY: , There is no significant past medical history noted today.,PHYSICAL EXAMINATION:,HEENT:  Patient denies ear abnormalities, nose abnormalities and throat abnormalities.,Cardio:  Patient has history of elevated cholesterol, but does not have ASHD, hypertension and PVD.,Resp:  Patient denies asthma, lung infections and lung lesions.,GI:  Patient denies colon abnormalities, gall bladder problems, liver abnormalities and peptic ulcer disease.,GU:  Patient has history of Urinary tract disorder, but does not have Bladder disorder and Kidney disorder.,Endocrine:  Patient has history of diabetes, but does not have hormonal irregularities and thyroid abnormalities.,Dermatology:  Patient denies allergic reactions, rashes and skin lesions.,MEDS:,  Micronase 2.5 mg Tab PO QAM #30.  Bactrim 400/80 Tab PO BID #30.,SOCIAL HISTORY:,  No known history of drug or alcohol abuse.  Work, diet, and exercise patterns are within normal limits.,FAMILY HISTORY:,  No significant family history.,REVIEW OF SYSTEMS:,  Non-contributory.,Vital Signs:  Height = 72 in.  Weight =184 lbs.  Upright BP = 120/80 mmHg.  Pulse = 80 bpm.  Resp =12 pm.  Patient is afebrile.,Neck:  The neck is supple.  There is no jugular venous distension.  The thyroid is nontender, or normal size and conto.,Lungs:  Lung expansion and excursions are symmetric.  The lungs are clear to auscultation and percussion.,Cardio:  There is a regular rhythm.  SI and S2 are normal.  No abnormal heart sounds are detected.  Blood pressure is equal bilaterally.,Abdomen:  Normal bowel sounds are present.  The abdomen is soft; The abdomen is nontender; without organomegaly; There is no CVA tenderness.  No hernias are noted.,Extremities:  There is no clubbing, cyanosis, or edema.,ASSESSMENT: , Diabetes type II uncontrolled.  Acute cystitis.,PLAN: , Endocrinology Consult, complete CBC.  ,RX: , Micronase 2.5 mg Tab PO QAM #30, Bactrim 400/80 Tab PO BID #30.", "last_modified": "2020-03-29 14:43:25.538944+00:00", "annotations": [{"id": 45610, "user": "wish", "cui": "C0005686", "value": "Bladder disorder", "start": 727, "end": 743, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:04.963047+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45611, "user": "wish", "cui": "C0011860", "value": "Diabetes type II", "start": 1961, "end": 1977, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:22.971441+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45612, "user": "wish", "cui": "C0085762", "value": "alcohol abuse", "start": 1072, "end": 1085, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:16.543377+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45613, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 461, "end": 473, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:39.944840+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45614, "user": "wish", "cui": "C0030920", "value": "peptic ulcer", "start": 635, "end": 647, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:55.170764+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45615, "user": "wish", "cui": "C0037284", "value": "skin lesions", "start": 939, "end": 951, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:09.327632+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45616, "user": "wish", "cui": "C0854135", "value": "infections", "start": 518, "end": 528, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:45.078963+00:00", "manually_created": false, "acc": 0.2189961876901541, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45617, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 144, "end": 152, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:26.019432+00:00", "manually_created": false, "acc": 0.6189171698870887, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45618, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 800, "end": 808, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:07.314908+00:00", "manually_created": false, "acc": 0.6618118296206791, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}, {"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45619, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 538, "end": 545, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:47.360059+00:00", "manually_created": false, "acc": 0.2678316210771088, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45620, "user": "wish", "cui": "C0002395", "value": "disease", "start": 648, "end": 655, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:08:59.745959+00:00", "manually_created": false, "acc": 0.4166455409661361, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45621, "user": "wish", "cui": "C0004096", "value": "asthma", "start": 505, "end": 511, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:42.301508+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45622, "user": "wish", "cui": "C0007222", "value": "Cardio", "start": 383, "end": 389, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:08:35.661505+00:00", "manually_created": false, "acc": 0.3241157459179974, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45623, "user": "wish", "cui": "C0023895", "value": "liver", "start": 611, "end": 616, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:08:53.437013+00:00", "manually_created": false, "acc": 0.44179782307727244, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45624, "user": "wish", "cui": "C0010054", "value": "ASHD", "start": 455, "end": 459, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:08:37.658986+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45625, "user": "wish", "cui": "C0242510", "value": "drug", "start": 1064, "end": 1068, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:09:15.003931+00:00", "manually_created": false, "acc": 0.5135172722580458, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45626, "user": "wish", "cui": "C0038454", "value": "CVA", "start": 1852, "end": 1855, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:19.052860+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3207, "name": "1383", "text": "CHIEF COMPLAINT:,  Toothache.,HISTORY OF PRESENT ILLNESS:  ,This is a 29-year-old male who has had multiple problems with his teeth due to extensive dental disease and has had many of his teeth pulled.  Complains of new tooth pain.  The patient states his current toothache is to both upper and lower teeth on the left side for approximately three days.  The patient states that he would have gone to see his regular dentist but he has missed so many appointments that they now do not allow him to schedule regular appointments, he has to be on standby appointments only.  The patient denies any other problems or complaints.  The patient denies any recent illness or injuries.  The patient does have OxyContin and Vicodin at home which he uses for his knee pain but he wants more pain medicines because he does not want to use up that medicine for his toothache when he wants to say this with me.,REVIEW OF SYSTEMS: , CONSTITUTIONAL:  No fever or chills.  No fatigue or weakness.  No recent weight change.  HEENT:  No headache, no neck pain, the toothache pain for the past three days as previously mentioned.  There is no throat swelling, no sore throat, no difficulty swallowing solids or liquids.  The patient denies any rhinorrhea.  No sinus congestion, pressure or pain, no ear pain, no hearing change, no eye pain or vision change.  CARDIOVASCULAR:  No chest pain.  RESPIRATIONS:  No shortness of breath or cough.  GASTROINTESTINAL:  No abdominal pain.  No nausea or vomiting.  GENITOURINARY:  No dysuria.  MUSCULOSKELETAL:  No back pain.  No muscle or joint aches.  SKIN:  No rashes or lesions.  NEUROLOGIC:  No vision or hearing change.  No focal weakness or numbness.  Normal speech.  HEMATOLOGIC/LYMPHATIC:  No lymph node swelling has been noted.,PAST MEDICAL HISTORY: , Chronic knee pain.,CURRENT MEDICATIONS: , OxyContin and Vicodin.,ALLERGIES:,  PENICILLIN AND CODEINE.,SOCIAL HISTORY: , The patient is still a smoker.,PHYSICAL EXAMINATION:,  VITAL SIGNS:  Temperature 97.9 oral, blood pressure is 146/83, pulse is 74, respirations 16, oxygen saturation 98% on room air and interpreted as normal.  CONSTITUTIONAL:  The patient is well nourished and well developed.  The patient is a little overweight but otherwise appears to be healthy.  The patient is calm, comfortable, in no acute distress, and looks well.  The patient is pleasant and cooperative.  HEENT:  Eyes are normal with clear conjunctiva and cornea bilaterally.  There is no icterus, injection, or discharge.  Pupils are 3 mm and equally round and reactive to light bilaterally.  There is no absence of light sensitivity or photophobia.  Extraocular motions are intact bilaterally.  Ears are normal bilaterally without any sign of infection.  There is no erythema, swelling of canals.  Tympanic membranes are intact without any erythema, bulging or fluid levels or bubbles behind it.  Nose is normal without rhinorrhea or audible congestion.  There is no tenderness over the sinuses.  NECK:  Supple, nontender, and full range of motion.  There is no meningismus.  No cervical lymphadenopathy.  No JVD.  Mouth and oropharynx shows multiple denture and multiple dental caries.  The patient has tenderness to tooth #12 as well as tooth #21.  The patient has normal gums.  There is no erythema or swelling.  There is no purulent or other discharge noted.  There is no fluctuance or suggestion of abscess.  There are no new dental fractures.  The oropharynx is normal without any sign of infection.  There is no erythema, exudate, lesion or swelling.  The buccal membranes are normal.  Mucous membranes are moist.  The floor of the mouth is normal without any abscess, suggestion of Ludwig's syndrome.  CARDIOVASCULAR:  Heart is regular rate and rhythm without murmur, rub, or gallop.  RESPIRATIONS:  Clear to auscultation bilaterally without shortness of breath.  GASTROINTESTINAL:  Abdomen is normal and nontender.  MUSCULOSKELETAL:  No abnormalities are noted to back, arms and legs.  The patient has normal use of his extremities.  SKIN:  No rashes or lesions.  NEUROLOGIC:  Cranial nerves II through XII are intact.  Motor and sensory are intact to the extremities.  The patient has normal speech and normal ambulation.  PSYCHIATRIC:  The patient is alert and oriented x4.  Normal mood and affect.  HEMATOLOGIC/LYMPHATIC:  No cervical lymphadenopathy is palpated.,EMERGENCY DEPARTMENT COURSE: , The patient did request a pain shot and the patient was given Dilaudid of 4 mg IM without any adverse reaction.,DIAGNOSES:,1.  ODONTALGIA.,2.  MULTIPLE DENTAL CARIES.,CONDITION UPON DISPOSITION:  ,Stable.,DISPOSITION: , To home.,PLAN: , The patient was given a list of local dental clinics that he can follow up with or he can choose to stay with his own dentist that he wishes.  The patient was requested to have reevaluation within two days.  The patient was given a prescription for Percocet and clindamycin.  The patient was given drug precautions for the use of these medicines.  The patient was offered discharge instructions on toothache but states that he already has it.  He declined the instructions.  The patient was asked to return to the emergency room, should he have any worsening of his condition or develop any other problems or symptoms of concern.", "last_modified": "2020-03-29 14:43:25.539562+00:00", "annotations": [{"id": 45627, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 3053, "end": 3068, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:58.255255+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45628, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 4312, "end": 4327, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:34.133576+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45629, "user": "wish", "cui": "C0011334", "value": "dental caries", "start": 3137, "end": 3150, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:10:01.692775+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45630, "user": "wish", "cui": "C0011334", "value": "DENTAL CARIES", "start": 4524, "end": 4537, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:45.517808+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45631, "user": "wish", "cui": "C0018939", "value": "HEMATOLOGIC", "start": 1695, "end": 1706, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:34.360399+00:00", "manually_created": false, "acc": 0.22995448598124954, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45632, "user": "wish", "cui": "C1561826", "value": "overweight", "start": 2204, "end": 2214, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:43.609627+00:00", "manually_created": false, "acc": 0.40765819622769134, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45633, "user": "wish", "cui": "C0276289", "value": "infection", "start": 2708, "end": 2717, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:45.289538+00:00", "manually_created": false, "acc": 0.3472818375532451, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45634, "user": "wish", "cui": "C0276289", "value": "infection", "start": 3460, "end": 3469, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:17.254714+00:00", "manually_created": false, "acc": 0.43685647165296126, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45635, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 2732, "end": 2740, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:51.532677+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45636, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 2805, "end": 2813, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:54.232734+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45637, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 3258, "end": 3266, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:10:19.475755+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45638, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 3484, "end": 3492, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:19.847993+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45639, "user": "wish", "cui": "C0000833", "value": "abscess", "start": 3369, "end": 3376, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:08.431015+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45640, "user": "wish", "cui": "C0000833", "value": "abscess", "start": 3632, "end": 3639, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:27.845421+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45641, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 1594, "end": 1601, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:09:31.576589+00:00", "manually_created": false, "acc": 0.6099575539229034, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45642, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 4028, "end": 4035, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:31.816445+00:00", "manually_created": false, "acc": 0.5407752127088525, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45643, "user": "wish", "cui": "C0238792", "value": "lesion", "start": 3503, "end": 3509, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:11:24.558034+00:00", "manually_created": false, "acc": 0.41279213922918384, "meta_anns": []}, {"id": 45644, "user": "wish", "cui": "C0242510", "value": "use", "start": 4932, "end": 4935, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:11:50.309731+00:00", "manually_created": false, "acc": 0.5099382027049228, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45645, "user": "wish", "cui": "C0026896", "value": "mg", "start": 4448, "end": 4450, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:11:38.946152+00:00", "manually_created": false, "acc": 0.3147452734907136, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3208, "name": "898", "text": "HISTORY: , A 34-year-old male presents today self-referred at the recommendation of Emergency Room physicians and his nephrologist to pursue further allergy evaluation and treatment.  Please refer to chart for history and physical, as well as the medical records regarding his allergic reaction treatment at ABC Medical Center for further details and studies.  In summary, the patient had an acute event of perioral swelling, etiology uncertain, occurring on 05/03/2008 requiring transfer from ABC Medical Center to XYZ Medical Center due to a history of renal failure requiring dialysis and he was admitted and treated and felt that his allergy reaction was to Keflex, which was being used to treat a skin cellulitis dialysis shunt infection.  In summary, the patient states he has some problems with tolerating grass allergies, environmental and inhalant allergies occasionally, but has never had anaphylactic or angioedema reactions.  He currently is not taking any medication for allergies.  He is taking atenolol for blood pressure control.  No further problems have been noted upon his discharge and treatment, which included corticosteroid therapy and antihistamine therapy and monitoring.,PAST MEDICAL HISTORY:,  History of urticaria, history of renal failure with hypertension possible source of renal failure, history of dialysis times 2 years and a history of hypertension.,PAST SURGICAL HISTORY:,  PermCath insertion times 3 and peritoneal dialysis.,FAMILY HISTORY: , Strong for heart disease, carcinoma, and a history of food allergies, and there is also a history of hypertension.,CURRENT MEDICATIONS: , Atenolol, sodium bicarbonate, Lovaza, and Dialyvite.,ALLERGIES: , Heparin causing thrombocytopenia.,SOCIAL HISTORY: , Denies tobacco or alcohol use.,PHYSICAL EXAMINATION:  ,VITAL SIGNS:  Age 34, blood pressure 128/78, pulse 70, temperature is 97.8, weight is 207 pounds, and height is 5 feet 7 inches.,GENERAL:  The patient is healthy appearing; alert and oriented to person, place and time; responds appropriately; in no acute distress.,HEAD:  Normocephalic.  No masses or lesions noted.,FACE:  No facial tenderness or asymmetry noted.,EYES:  Pupils are equal, round and reactive to light and accommodation bilaterally.  Extraocular movements are intact bilaterally.,EARS:  The tympanic membranes are intact bilaterally with a good light reflex.  The external auditory canals are clear with no lesions or masses noted.  Weber and Rinne tests are within normal limits.,NOSE:  The nasal cavities are patent bilaterally.  The nasal septum is midline.  There are no nasal discharges.  No masses or lesions noted.,THROAT:  The oral mucosa appears healthy.  Dental hygiene is maintained well.  No oropharyngeal masses or lesions noted.  No postnasal drip noted.,NECK:  The neck is supple with no adenopathy or masses palpated.  The trachea is midline.  The thyroid gland is of normal size with no nodules.,NEUROLOGIC:  Facial nerve is intact bilaterally.  The remaining cranial nerves are intact without focal deficit.,LUNGS:  Clear to auscultation bilaterally.  No wheeze noted.,HEART:  Regular rate and rhythm.  No murmur noted.,IMPRESSION:  ,1.  Acute allergic reaction, etiology uncertain, however, suspicious for Keflex.,2.  Renal failure requiring dialysis.,3.  Hypertension.,RECOMMENDATIONS:  ,RAST allergy testing for both food and environmental allergies was performed, and we will get the results back to the patient with further recommendations to follow.  If there is any specific food or inhalant allergen that is found to be quite high on the sensitivity scale, we would probably recommend the patient to avoid the offending agent to hold off on any further reactions.  At this point, I would recommend the patient stopping any further use of cephalosporin antibiotics, which may be the cause of his allergic reaction, and I would consider this an allergy.  Being on atenolol, the patient has a more difficult time treating acute anaphylaxis, but I do think this is medically necessary at this time and hopefully we can find specific causes for his allergic reactions.  An EpiPen was also prescribed in the event of acute angioedema or allergic reaction or sensation of impending allergic reaction and he is aware he needs to proceed directly to the emergency room for further evaluation and treatment recommendations after administration of an EpiPen.", "last_modified": "2020-03-29 14:43:25.540195+00:00", "annotations": [{"id": 45646, "user": "wish", "cui": "C0040034", "value": "thrombocytopenia", "start": 1700, "end": 1716, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:10.552207+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45647, "user": "wish", "cui": "C0035078", "value": "renal failure", "start": 555, "end": 568, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:48.914834+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45648, "user": "wish", "cui": "C0035078", "value": "renal failure", "start": 1254, "end": 1267, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:52.106478+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45649, "user": "wish", "cui": "C0035078", "value": "renal failure", "start": 1305, "end": 1318, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:54.009724+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45650, "user": "wish", "cui": "C0018799", "value": "heart disease", "start": 1491, "end": 1504, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:57.541986+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45651, "user": "wish", "cui": "C0035078", "value": "Renal failure", "start": 3243, "end": 3256, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:31.998007+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45652, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1273, "end": 1285, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:53.041028+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45653, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1371, "end": 1383, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:55.734929+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45654, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1581, "end": 1593, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:04.949054+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45655, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 3281, "end": 3293, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:35.696490+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45656, "user": "wish", "cui": "C0042109", "value": "urticaria", "start": 1232, "end": 1241, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:13:50.372294+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45657, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2092, "end": 2099, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:12.152359+00:00", "manually_created": false, "acc": 0.3704270896102714, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}, {"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45658, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2613, "end": 2620, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:19.128936+00:00", "manually_created": false, "acc": 0.3315342964752096, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45659, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2734, "end": 2741, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:23.941239+00:00", "manually_created": false, "acc": 0.30666852142678713, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45660, "user": "wish", "cui": "C0267797", "value": "Acute", "start": 3162, "end": 3167, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:14:30.776289+00:00", "manually_created": false, "acc": 0.3295163435531775, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3209, "name": "1734", "text": "REASON FOR CONSULTATION:,  Cardiac evaluation.,HISTORY: , This is a 42-year old Caucasian male with no previous history of hypertension, diabetes mellitus, rheumatic fever, rheumatic heart disease, or gout.  Patient used to take medicine for hyperlipidemia and then that was stopped.  He used to live in Canada and he moved to Houston four months ago.  He started complaining of right-sided upper chest pain, starts at the right neck and goes down to the right side.  It lasts around 10-15 minutes at times.  It is 5/10 in quality.  It is not associated with shortness of breath, nausea, vomiting, or sweating.  It is not also associated with food.  He denies exertional chest pain, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or pedal edema.  No palpitations, syncope or presyncope.  He said he has been having little cough at night and he went to see an allergy doctor who prescribed several medications for him and told him that he has asthma.  No fever, chills, cough, hemoptysis, hematemesis or hematochezia.  His EKG shows normal sinus rhythm, normal EKG.,PAST MEDICAL HISTORY:,  Unremarkable, except for hyperlipidemia.,SOCIAL HISTORY: , He said he quit smoking 20 years ago and does not drink alcohol.,FAMILY HISTORY: , Positive for high blood pressure and heart disease.  His father died in his 50s with an acute myocardial infarction.,MEDICATION:,  Ranitidine 300 mg daily, Flonase 50 mcg nasal spray as needed, Allegra 100 mg daily, Advair 500/50 bid.,ALLERGIES:,  No known allergies.,REVIEW OF SYSTEMS:,  As mentioned above,EXAMINATION:,  This is a 42-year old male awake, alert, and oriented x3 in no acute distress.,Wt:  238", "last_modified": "2020-03-29 14:43:25.540767+00:00", "annotations": [{"id": 45661, "user": "wish", "cui": "C0155626", "value": "acute myocardial infarction", "start": 1334, "end": 1361, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:15:15.107939+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45662, "user": "wish", "cui": "C0035439", "value": "rheumatic heart disease", "start": 173, "end": 196, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:50.850936+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45663, "user": "wish", "cui": "C0020538", "value": "high blood pressure", "start": 1259, "end": 1278, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:15:09.809614+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45664, "user": "wish", "cui": "C0011849", "value": "diabetes mellitus", "start": 137, "end": 154, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:46.956775+00:00", "manually_created": false, "acc": 0.5773470660791813, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45665, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 242, "end": 256, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:58.292795+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45666, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 1129, "end": 1143, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:15:07.201170+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45667, "user": "wish", "cui": "C0018799", "value": "heart disease", "start": 1283, "end": 1296, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:15:12.122883+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45668, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 123, "end": 135, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:43.611443+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45669, "user": "wish", "cui": "C0035435", "value": "rheumatic", "start": 156, "end": 165, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:48.795566+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45670, "user": "wish", "cui": "C0004096", "value": "asthma", "start": 957, "end": 963, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:15:02.340351+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45671, "user": "wish", "cui": "C0018099", "value": "gout", "start": 201, "end": 205, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:14:53.013518+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3210, "name": "716", "text": "REASON FOR CONSULTATION: , Mesothelioma.,HISTORY OF PRESENT ILLNESS: , The patient is a 73-year-old pleasant Caucasian male who is known to me from his previous hospitalization.  He has also been seen by me in the clinic in the last few weeks.  He was admitted on January 18, 2008, with recurrent malignant pleural effusion.  On the same day, he underwent VATS and thoracoscopic drainage of the pleural effusion with right pleural nodule biopsy, lysis of adhesions, and directed talc insufflation by Dr. X.  He was found to have 2.5L of bloody pleural effusions, some loculated pleural effusion, adhesions, and carcinomatosis in the parenchyma.  His hospital course here has been significant for dyspnea, requiring ICU stay.  He also had a chest tube, which was taken out few days ago.  He has also had paroxysmal atrial fibrillation, for which he has been on amiodarone by cardiologist.  The biopsy from the pleural nodule done on the right on January 18, 2008, shows malignant epithelioid neoplasm consistent with mesothelioma.  Immunohistochemical staining showed tumor cells positive for calretinin and focally positive for D2-40, MOC-31.  Tumor cells are negative for CDX-2, and monoclonal CEA.,The patient at this time reports that overall he has been feeling better with decrease in shortness of breath and cough over the last few days.  He does have edema in his lower extremities.  He is currently on 4L of oxygen.  He denies any nausea, vomiting, abdominal pain, recent change in bowel habit, melena, or hematochezia.  No neurological or musculoskeletal signs or symptoms.  He reports that he is able to ambulate to the bathroom, but gets short of breath on exertion.  He denies any other complaints.,PAST MEDICAL HISTORY:,  Left ventricular systolic dysfunction as per the previous echocardiogram done in December 2007, history of pneumonia in December 2007, admitted to XYZ Hospital.  History of recurrent pleural effusions, status post pleurodesis and locally advanced non-small cell lung cancer as per the biopsy that was done in XYZ Hospital.,ALLERGIES:,  No known drug allergies.,CURRENT MEDICATIONS:  ,In the hospital are amiodarone, diltiazem, enoxaparin, furosemide, methylprednisolone, pantoprazole, Zosyn, p.r.n. acetaminophen, and hydrocodone.,SOCIAL HISTORY: , The patient is married and lives with his spouse.  He has history of tobacco smoking and also reports history of alcohol abuse.  No history of illicit drug abuse.,FAMILY HISTORY:  ,Significant for history of ?cancer? in the mother and history of coronary artery disease in the father.,REVIEW OF SYSTEMS: , As stated above.  He denies any obvious asbestos exposure, as far as he can remember.,PHYSICAL EXAMINATION,GENERAL:  He is awake, alert, in no acute distress.  He is currently on 4L of oxygen by nasal cannula.,VITAL SIGNS:  Blood pressure 97/65 mmHg, respiration is 20 per minute, pulse is 72 per minute, and temperature 98.3 degrees Fahrenheit.,HEENT:  No icterus or sinus tenderness.  Oral mucosa is moist.,NECK:  Supple.  No lymphadenopathy.,LUNGS:  Clear to auscultation except few diffuse wheezing present bilaterally.,CARDIOVASCULAR:  S1 and S2 normal.,ABDOMEN:  Soft, nondistended, and nontender.  No hepatosplenomegaly.  Bowel sounds are present in all four quadrants.,EXTREMITIES:  Bilateral pedal edema is present in both the extremities.  No signs of DVT.,NEUROLOGICAL:  Grossly nonfocal.,INVESTIGATION:,  Labs done on January 28, 2008, showed BUN of 23 and creatinine of 0.9.  Liver enzymes checked on January 17, 2008, were unremarkable.  CBC done on January 26, 2008, showed WBC of 19.8, hemoglobin of 10.7, hematocrit of 30.8, and platelet count of 515,000.  Chest x-ray from yesterday shows right-sided Port-A-Cath, diffuse right lung parenchymal and pleural infiltration without change, mild pulmonary vascular congestion.,ASSESSMENT,1.  Mesothelioma versus primary lung carcinoma, two separate reports as for the two separate biopsies done several weeks apart.,2.  Chronic obstructive pulmonary disease.,3.  Paroxysmal atrial fibrillation.,4.  Malignant pleural effusion, status post surgery as stated above.,5.  Anemia of chronic disease.,RECOMMENDATIONS,1.  Compare the slides from the previous biopsy done in December at XYZ Hospital with recurrent pleural nodule biopsy slides.  I have discussed regarding this with Dr. Y in Pathology here at Methodist XYZ Hospital.  I will try to obtain the slides for comparison from XYZ Hospital for comparison and immunohistochemical staining.,2.  I will also discuss with Dr. X and also with intervention radiologist at XYZ Hospital regarding the exact sites of the two biopsies.,3.  Once the results of the above are available, I will make further recommendations regarding treatment.  The patient has significantly decreased performance status with dyspnea on exertion and is being planned for transfer to Triumph Hospital for rehab, which I agree with.,4.  Continue present care.,Discussed regarding the above in great details with the patient and his wife and daughter and answered the questions to their satisfaction.  They clearly understand the above.  They also understand his very poor performance status at this time, and the risks and benefits of delaying chemotherapy due to this.", "last_modified": "2020-03-29 14:43:25.541346+00:00", "annotations": [{"id": 45672, "user": "wish", "cui": "C1277187", "value": "Left ventricular systolic dysfunction", "start": 1735, "end": 1772, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:28.599815+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45673, "user": "wish", "cui": "C0024117", "value": "Chronic obstructive pulmonary disease", "start": 3973, "end": 4010, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:56.258036+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45674, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 2530, "end": 2553, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:39.941833+00:00", "manually_created": false, "acc": 0.6704740826100033, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45675, "user": "wish", "cui": "C0004238", "value": "atrial fibrillation", "start": 814, "end": 833, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:27.227336+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45676, "user": "wish", "cui": "C0004238", "value": "atrial fibrillation", "start": 4027, "end": 4046, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:59.503170+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45677, "user": "wish", "cui": "C0032227", "value": "pleural effusions", "start": 544, "end": 561, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:25.329478+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45678, "user": "wish", "cui": "C0032227", "value": "pleural effusions", "start": 1918, "end": 1935, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:32.987492+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45679, "user": "wish", "cui": "C0032227", "value": "pleural effusion", "start": 307, "end": 323, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:22.392246+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45680, "user": "wish", "cui": "C0032227", "value": "pleural effusion", "start": 395, "end": 411, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:23.567032+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45681, "user": "wish", "cui": "C0032227", "value": "pleural effusion", "start": 578, "end": 594, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:26.519053+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45682, "user": "wish", "cui": "C0032227", "value": "pleural effusion", "start": 4062, "end": 4078, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:00.564067+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45683, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 3018, "end": 3033, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:43.254487+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45684, "user": "wish", "cui": "C0008679", "value": "chronic disease", "start": 4131, "end": 4146, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:06.988150+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45685, "user": "wish", "cui": "C0085762", "value": "alcohol abuse", "start": 2397, "end": 2410, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:34.180610+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45686, "user": "wish", "cui": "C0013146", "value": "drug abuse", "start": 2435, "end": 2445, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:37.214252+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45687, "user": "wish", "cui": "C0032285", "value": "pneumonia", "start": 1842, "end": 1851, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:31.742070+00:00", "manually_created": false, "acc": 0.5295302438470427, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45688, "user": "wish", "cui": "C0002871", "value": "Anemia", "start": 4121, "end": 4127, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:05.196366+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45689, "user": "wish", "cui": "C0149871", "value": "DVT", "start": 3352, "end": 3355, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:16:53.905564+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3219, "name": "879", "text": "CHIEF COMPLAINT: , \"Bloody bump on penis.\",HISTORY OF PRESENT ILLNESS: , This is a 29-year-old African-American male who presents to the Emergency Department today with complaint of a bleeding bump on his penis.  The patient states that he has had a large bump on the end of his penis for approximately a year and a half.  He states that it has never bled before.  It has never caused him any pain or has never been itchy.  The patient states that he is sexually active, but has been monogamous with the same person for the past 13 years.  He states that he believes that his sexual partner is monogamous as well and reciprocates in this practice.  The patient does state that last night he was \"trying to get some,\" meaning that he was engaging in sexual intercourse, at which time this bump bent backwards and ripped a portion of the skin on the tip of his penis.  The patient said that there is a large amount of blood from this injury.  This happened last night, but he was embarrassed to come to the Emergency Department yesterday when it was bleeding.  The patient has been able to get the bleeding to stop, but the large bump is still located on the end of his penis, and he is concerned that it will rip off, and does want it removed.  The patient denies any drainage or discharge from his penis.  He denies fevers or chills recently.  He also denies nausea or vomiting.  The patient has not had any discharge from his penis.  He has not had any other skin lesions on his penis that are new to him.  He states that he has had numerous bumps along the head of his penis and on the shaft of his penis for many years.  The patient has never had these checked out.  He denies fevers, chills, or night sweats.  He denies unintentional weight gain or loss.  He denies any other bumps, rashes, or lesions throughout the skin on his body.,PAST MEDICAL HISTORY:  ,No significant medical problems.,PAST SURGICAL HISTORY: , Surgery for excision of a bullet after being shot in the back.,SOCIAL HABITS: , The patient denies illicit drug usage.  He occasionally smokes tobacco and drinks alcohol.,MEDICATIONS: , None.,ALLERGIES: , No known medical allergies.,PHYSICAL EXAMINATION:  ,GENERAL:  This is an African-American male who appears his stated age of 29 years.  He is well nourished, well developed, in no acute distress.  The patient is pleasant.  He is sitting on a Emergency Department gurney.,VITAL SIGNS:  Temperature 98.4 degrees Fahrenheit, blood pressure of 139/78, pulse of 83, respiratory rate of 18, and pulse oximetry of 98% on room air.,HEART:  Regular rate and rhythm.  Clear S1, S2.  No murmur, rub, or gallop is appreciated.,LUNGS:  Clear to auscultation bilaterally.  No wheezes, rales, or rhonchi.,ABDOMEN:  Soft, nontender, nondistended, and positive bowel sounds throughout.,GENITOURINARY:  The patient's external genitalia is markedly abnormal.  There is a large pedunculated mass dangling from the glans of the penis at approximately the urethral meatus.  This pedunculated mass is approximately 1.5 x 2 cm in size and pedunculated by a stalk that is approximately 2 mm in diameter.  The patient appears to have condylomatous changes along the glans of the penis and on the shaft of the penis as well.  There are no open lesions at this point.  There is a small tear of the skin where the mass attaches to the glans near the urethral meatus.  Bleeding is currently stanch, and there is no sign of secondary infection at this time.  Bilateral testicles are descended and normal without pain or mass bilaterally.  There is no inguinal adenopathy.,EXTREMITIES:  No edema.,SKIN:  Warm, dry, and intact.  No rash or lesion.,DIAGNOSTIC STUDIES:  ,Non-emergency department courses.  It is thought that this patient should proceed directly with a referral to Urology for excision and biopsy of this mass.,ASSESSMENT AND PLAN: , Penile mass.  The patient does have a large pedunculated penile mass.  He will be referred to the urologist who is on-call today.  The patient will need this mass excised and biopsied.  The patient verbalized understanding the plan of followup and is discharged in satisfactory condition from the ER.,", "last_modified": "2020-03-29 14:43:25.546568+00:00", "annotations": [{"id": 45708, "user": "wish", "cui": "C0442886", "value": "secondary infection", "start": 3419, "end": 3438, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:39.337200+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45709, "user": "wish", "cui": "C0037284", "value": "skin lesions", "start": 1460, "end": 1472, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:23.095842+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45710, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 1798, "end": 1805, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:29.683323+00:00", "manually_created": false, "acc": 0.5152935955197913, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45711, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 3243, "end": 3250, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:36.386503+00:00", "manually_created": false, "acc": 0.5041846704136316, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45712, "user": "wish", "cui": "C0037284", "value": "lesion", "start": 3633, "end": 3639, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:46.446153+00:00", "manually_created": false, "acc": 0.4671035161056112, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3220, "name": "1881", "text": "CHIEF COMPLAINT:,  Joints are hurting all over and checkup.,HISTORY OF PRESENT ILLNESS:,  A 77-year-old white female who is having more problems with joint pain.  It seems to be all over decreasing her mobility, hands and wrists.  No real swelling but maybe just a little more uncomfortable than they have been.  The Daypro generic does not seem to be helping at all.  No fever or chills.  No erythema.,She actually is doing better.  Her diarrhea now has settled down and she is having less urinary incontinence, less pedal edema.  Blood sugars seem to be little better as well.,The patient also has gotten back on her Zoloft because she thinks she may be depressed, sleeping all the time, just not herself and really is disturbed that she cannot be more mobile in things.  She has had no polyuria, polydipsia, or other problems.  No recent blood pressure checks.,PAST MEDICAL HISTORY:,  Little over a year ago, the patient was found to have lumbar discitis and was treated with antibiotics and ended up having debridement and instrumentation with Dr. XYZ and is doing really quite well.  She had a pulmonary embolus with that hospitalization.,PAST SURGICAL HISTORY:,  She has also had a hysterectomy, salpingoophorectomy, appendectomy, tonsillectomy, two carpal tunnel releases.  She also has had a parathyroidectomy but still has had some borderline elevated calcium.  Also, hypertension, hyperlipidemia, as well as diabetes.  She also has osteoporosis.,SOCIAL HISTORY:,  The patient still smokes about a third of a pack a day, also drinks only occasional alcoholic drinks.  The patient is married.  She has three grown sons, all of which are very successful in professional positions.  One son is a gastroenterologist in San Diego, California.,MEDICATIONS:,  Nifedipine-XR 90 mg daily, furosemide 20 mg half tablet b.i.d., lisinopril 20 mg daily, gemfibrozil 600 mg b.i.d., Synthroid 0.1 mg daily, Miacalcin one spray in alternate nostrils daily, Ogen 0.625 mg daily, Daypro 600 mg t.i.d., also Lortab 7.5 two or three a day, also Flexeril occasionally, also other vitamin.,ALLERGIES: , She had some adverse reactions to penicillin, sulfa, perhaps contrast medium, and some mycins.,FAMILY HISTORY:,  As far as heart disease there is none in the family.  As far as cancer two cousins had breast cancer.  As far as diabetes father and grandfather had type II diabetes.  Son has type I diabetes and is struggling with that at the moment.,REVIEW OF SYSTEMS:,General:  No fever, chills, or night sweats.  Weight stable.,HEENT:  No sudden blindness, diplopia, loss of vision, i.e., in one eye or other visual changes.  No hearing changes or ear problems.  No swallowing problems or mouth lesions.,Endocrine:  Hypothyroidism but no polyuria or polydipsia.  She watches her blood sugars.  They have been doing quite well.,Respiratory:  No shortness of breath, cough, sputum production, hemoptysis or breathing problems.,Cardiovascular:  No chest pain or chest discomfort.  No paroxysmal nocturnal dyspnea, orthopnea, palpitations, or heart attacks.,GI:  As mentioned, has had diarrhea though thought to be possibly due to Clostridium difficile colitis that now has gotten better.  She has had some irritable bowel syndrome and bowel abnormalities for years.,GU:  No urinary problems, dysuria, polyuria or polydipsia, kidney stones, or recent infections.  No vaginal bleeding or discharge.,Musculoskeletal:  As above.,Hematological:  She has had some anemia in the past.,Neurological:  No blackouts, convulsions, seizures, paralysis, strokes, or headaches.,PHYSICAL EXAMINATION:,Vital Signs:  Weight is 164 pounds.  Blood pressure:  140/64.  Pulse:  72.  Blood pressure repeated by me with the patient sitting taken on the right arm is 148/60, left arm 136/58; these are while sitting on the exam table.,General:  A well-developed pleasant female who is comfortable in no acute distress otherwise but she does move slowly.,HEENT:  Skull is normocephalic.  TMs intact and shiny with good auditory acuity to finger rub.  Pupils equal, round, reactive to light and accommodation with extraocular movements intact.  Fundi benign.  Sclerae and conjunctivae were normal.,Neck:  No thyromegaly or cervical lymphadenopathy.  Carotids are 2+ and equal bilaterally and no bruits present.,Lungs:  Clear to auscultation and percussion with good respiratory movement.  No bronchial breath sounds, egophony, or rales are present.,Heart:  Regular rhythm and rate with no murmurs, gallops, rubs, or enlargement.  PMI normal position.  All pulses are 2+ and equal bilaterally.,Abdomen:  Obese, soft with no hepatosplenomegaly or masses.,Breasts:  No predominant masses, discharge, or asymmetry.,Pelvic Exam:  Normal external genitalia, vagina and cervix.  Pap smear done.  Bimanual exam shows no uterine enlargement and is anteroflexed.  No adnexal masses or tenderness.  Rectal exam is normal with soft brown stool Hemoccult negative.,Extremities:  The patient does appear to have some doughiness of all of the MCP joints of the hands and the wrists as well.  No real erythema.  There is no real swelling of the knees.  No new pedal edema.,Lymph nodes:  No cervical, axillary, or inguinal adenopathy.,Neurological:  Cranial nerves II-XII are grossly intact.  Deep tendon reflexes are 2+ and equal bilaterally.  Cerebellar and motor function intact in all extremities.  Good vibratory and positional sense in all extremities and dermatomes.  Plantar reflexes are downgoing bilaterally.,LABORATORY:  ,CBC shows a hemoglobin of 10.5, hematocrit 35.4, otherwise normal.  Urinalysis is within normal limits.  Chem profile showed a BUN of 54, creatinine 1.4, glucose 116, calcium was 10.8, cholesterol 198, triglycerides 171, HDL 43, LDL 121, TSH is normal, hemoglobin A1C is 5.3.,ASSESSMENT:,1.  Arthralgias that are suspicious for inflammatory arthritis, but certainly seems to be more active and bothersome.  I think we need to look at this more closely.,2.  Diarrhea that seems to have resolved.  Whether this is related to the above is unclear.,3.  Diabetes mellitus type II, really fairly well controlled.", "last_modified": "2020-03-29 14:43:25.547151+00:00", "annotations": [{"id": 45713, "user": "wish", "cui": "C0022104", "value": "irritable bowel syndrome", "start": 3193, "end": 3217, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:59.636993+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45714, "user": "wish", "cui": "C0003864", "value": "inflammatory arthritis", "start": 5805, "end": 5827, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:19.383165+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45715, "user": "wish", "cui": "C0034065", "value": "pulmonary embolus", "start": 1099, "end": 1116, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:04.846833+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45716, "user": "wish", "cui": "C0011849", "value": "Diabetes mellitus", "start": 6026, "end": 6043, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:24.539470+00:00", "manually_created": false, "acc": 0.742267263706876, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45717, "user": "wish", "cui": "C0011854", "value": "type I diabetes", "start": 2379, "end": 2394, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:24.272403+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45718, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 4193, "end": 4208, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:07.556477+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45719, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 1391, "end": 1405, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:07.392262+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45720, "user": "wish", "cui": "C1398668", "value": "loss of vision", "start": 2557, "end": 2571, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:28.385131+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45721, "user": "wish", "cui": "C0020676", "value": "Hypothyroidism", "start": 2706, "end": 2720, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:36.928759+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45722, "user": "wish", "cui": "C1301700", "value": "Cardiovascular", "start": 2915, "end": 2929, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:39.234439+00:00", "manually_created": false, "acc": 0.25777777799090396, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45723, "user": "wish", "cui": "C0018799", "value": "heart disease", "start": 2213, "end": 2226, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:11.149312+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45724, "user": "wish", "cui": "C0021167", "value": "incontinence", "start": 499, "end": 511, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:56.081103+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45725, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1377, "end": 1389, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:06.209200+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45726, "user": "wish", "cui": "C0029456", "value": "osteoporosis", "start": 1442, "end": 1454, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:10.079774+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45727, "user": "wish", "cui": "C0011570", "value": "depressed", "start": 656, "end": 665, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:01.952187+00:00", "manually_created": false, "acc": 0.49230332138606425, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45728, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 393, "end": 401, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:17:53.935885+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45729, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 5046, "end": 5054, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:16.822730+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45730, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 1418, "end": 1426, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:08.423141+00:00", "manually_created": false, "acc": 0.5279517237798568, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45731, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 2316, "end": 2324, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:12.666208+00:00", "manually_created": false, "acc": 0.46348884049664657, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}, {"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45732, "user": "wish", "cui": "C0011849", "value": "diabetes", "start": 2360, "end": 2368, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:22.001765+00:00", "manually_created": false, "acc": 0.7269673077658119, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45733, "user": "wish", "cui": "C0038454", "value": "strokes", "start": 3528, "end": 3535, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:04.792289+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45734, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2685, "end": 2692, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:33.352171+00:00", "manually_created": false, "acc": 0.25067711295738243, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45735, "user": "wish", "cui": "C0009324", "value": "colitis", "start": 3139, "end": 3146, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:18:48.185934+00:00", "manually_created": false, "acc": 0.5057932935104288, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45736, "user": "wish", "cui": "C0002871", "value": "anemia", "start": 3445, "end": 3451, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:03.017818+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45737, "user": "wish", "cui": "C3839342", "value": "PMI", "start": 4491, "end": 4494, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:19:15.588806+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3221, "name": "899", "text": "CHIEF COMPLAINT:  ,Followup diabetes mellitus, type 1., ,SUBJECTIVE:,  Patient is a 34-year-old male with significant diabetic neuropathy.  He has been off on insurance for over a year.  Has been using NPH and Regular insulin to maintain his blood sugars.  States that he is deathly afraid of having a low blood sugar due to motor vehicle accident he was in several years ago.  Reports that his blood sugar dropped too low which caused the accident.  Since this point in time, he has been unwilling to let his blood sugars fall within a normal range, for fear of hypoglycemia. Also reports that he regulates his blood sugars with how he feels, rarely checking his blood sugar with a glucometer., ,Reports that he has been worked up extensively at hospital and was seeing an Endocrinologist at one time.  Reports that he had some indications of kidney damage when first diagnosed.  His urine microalbumin today is 100.  His last hemoglobin A1C drawn at the end of December is 11.9.  Reports that at one point, he was on Lantus which worked well and he did not worry about his blood sugars dropping too low. While using Lantus, he was able to get his hemoglobin A1C down to 7.  His last CMP shows an elevated alkaline phosphatase level of 168. He denies alcohol or drug use and is a non smoker.  Reports he quit drinking 3 years ago. I have discussed with patient that it would be appropriate to do an SGGT and hepatic panel today.  Patient also has a history of gastroparesis and impotence.  Patient requests Nexium and Viagra, neither of which are covered under the Health Plan.  , ,Patient reports that he was in a scooter accident one week ago, fell off his scooter, hit his head.  Was not wearing a helmet.  Reports that he did not go to the emergency room and had a headache for several days after this incident.  Reports that an ambulance arrived at the scene and he was told he had a scalp laceration and to go into the emergency room.  Patient did not comply.  Reports that the headache has resolved.  Denies any dizziness, nausea, vomiting, or other neurological abnormalities., ,PHYSICAL EXAMINATION: , WD, WN.  Slender, 34-year-old white male.  VITAL SIGNS:  Blood sugar 145, blood pressure 120/88, heart rate 104, respirations 16.  Microalbumin 100. SKIN:  There appears to be 2 skin lacerations on the left parietal region of the scalp, each approximately 1 inch long.  No signs of infection.  Wound is closed with new granulation tissue.  Appears to be healing well.  HEENT:  Normocephalic.  PERRLA.  EOMI.  TMs pearly gray with landmarks present.  Nares patent.  Throat with no redness or swelling.  Nontender sinuses.  NECK:  Supple.  Full ROM.  No LAD. CARDIAC:", "last_modified": "2020-03-29 14:43:25.547742+00:00", "annotations": [{"id": 45738, "user": "wish", "cui": "C0011882", "value": "diabetic neuropathy", "start": 118, "end": 137, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:45.929726+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45739, "user": "wish", "cui": "C0011849", "value": "diabetes mellitus", "start": 28, "end": 45, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:35.850631+00:00", "manually_created": false, "acc": 0.5820445154937393, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45740, "user": "wish", "cui": "C0020615", "value": "hypoglycemia", "start": 563, "end": 575, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:47.756229+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45741, "user": "wish", "cui": "C0242510", "value": "drug use", "start": 1263, "end": 1271, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:00.358583+00:00", "manually_created": false, "acc": 0.5321961264070647, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45742, "user": "wish", "cui": "C0041834", "value": "redness", "start": 2592, "end": 2599, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:02.834249+00:00", "manually_created": false, "acc": 0.47738844639500944, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45743, "user": "wish", "cui": "C0011854", "value": "type 1", "start": 47, "end": 53, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:19:38.161038+00:00", "manually_created": false, "acc": 0.37124041351925124, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3240, "name": "1557", "text": "PRESENT ILLNESS: , The patient is a very pleasant 69-year-old Caucasian male whom we are asked to see primarily because of a family history of colon cancer, but the patient also has rectal bleeding on a weekly basis and also heartburn once every 1 or 2 weeks.  The patient states that he had his first colonoscopy 6 years ago and it was negative.  His mother was diagnosed with colon cancer probably in her 50s, but she died of cancer of the esophagus at age 86.  The patient does have hemorrhoidal bleed about once a week.  Otherwise, he denies any change in bowel habits, abdominal pain, or weight loss.  He gets heartburn mainly with certain food such as raw onions and he has had it for years.  It will typically occur every couple of weeks.  He has had no dysphagia.  He has never had an upper endoscopy.,MEDICAL HISTORY: , Remarkable for hypertension, adult-onset diabetes mellitus, hyperlipidemia, and restless legs syndrome.,SURGICAL HISTORY: , Appendectomy as a child and cholecystectomy in 2003.,MEDICATIONS:  ,His medications are lisinopril 40 mg daily, hydrochlorothiazide 25 mg daily, metformin 1000 mg twice a day, Januvia 100 mg daily, clonazepam 10 mg at bedtime for restless legs syndrome, Crestor 10 mg nightly, and Flomax 0.4 mg daily.,ALLERGIES: , No known drug allergies.,SOCIAL HISTORY: , The patient is retired.  He is married.  He had 4 children.  He quite smoking 25 years ago after a 35-year history of smoking.  He does not drink alcohol.,FAMILY HISTORY: , Mother had colon cancer in her 50s, esophageal cancer in her 80s.  Her mother smoked and drank.  Father got a mesothelioma at age 65.  There is a brother of 65 with hypertension.,REVIEW OF SYSTEMS: , He has had prostatitis with benign prostatic hypertrophy.  He has some increased urinary frequency from a history of prostatitis.  He has the heartburn, which is diet dependent and the frequent rectal bleeding.  He also has restless legs syndrome at night.  No cardio or pulmonary complaints.  No weight loss.,PHYSICAL EXAMINATION: , Reveals a well-developed, well-nourished man in no acute distress.  BP 112/70.  Pulse 80 and regular.  Respirations non-labored.  Height 5 feet 7-1/2 inches.  Weight 209 pounds.  HEENT exam:  Sclerae are anicteric.  Pupils equal, conjunctivae clear.  No gross oropharyngeal lesions.  Neck is supple without lymphadenopathy, thyromegaly, or JVD.  Lungs are clear to percussion and auscultation.  Heart sounds are regular without murmur, gallop, or rub.  The abdomen is soft and nontender.  There are no masses.  There is no hepatosplenomegaly.  The bowel sounds are normal.  Rectal examination:  Deferred.  Extremities have no clubbing, cyanosis or edema.  Skin is warm and dry.  The patient is alert and oriented with a pleasant affect and no gross motor deficits.,IMPRESSION:,1.  Family history of colon cancer.,2.  Rectal bleeding.,3.  Heartburn and a family history of esophageal cancer.,PLAN:,  I agree with the indications for repeat colonoscopy, which should be done at least every 5 years.  Also, discussed IRC to treat bleeding and internal hemorrhoids if he is deemed to be an appropriate candidate at the time of his colonoscopy and the patient was agreeable.  I am also a little concerned about his family history of esophageal cancer and his personal history of heartburn and suggested that we check him once for Barrett's esophagus.  If he does not have it now then it should not be a significant risk in the future.  The indications and benefits of EGD, colonoscopy, and IRC were discussed.  The risks including sedation, bleeding, infection, and perforation were discussed.  The importance of a good bowel prep so as to minimize missing any lesions was discussed.  His questions were answered and informed consent obtained.  It was a pleasure to care for this nice patient.", "last_modified": "2020-03-29 14:43:25.558593+00:00", "annotations": [{"id": 45774, "user": "wish", "cui": "C0011849", "value": "diabetes mellitus", "start": 870, "end": 887, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:24.432973+00:00", "manually_created": false, "acc": 0.5869456264251296, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45775, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 2325, "end": 2340, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:43.435652+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45776, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 889, "end": 903, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:25.282421+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45777, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 844, "end": 856, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:23.343756+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45778, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1649, "end": 1661, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:26.787636+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45779, "user": "wish", "cui": "C0033581", "value": "prostatitis", "start": 1695, "end": 1706, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:31.099140+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45780, "user": "wish", "cui": "C0033581", "value": "prostatitis", "start": 1801, "end": 1812, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:33.994484+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45781, "user": "wish", "cui": "C0011168", "value": "dysphagia", "start": 761, "end": 770, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:20.626741+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45782, "user": "wish", "cui": "C0039082", "value": "syndrome", "start": 923, "end": 931, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:25.981620+00:00", "manually_created": false, "acc": 0.3717077955474978, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45783, "user": "wish", "cui": "C0039082", "value": "syndrome", "start": 1922, "end": 1930, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:37.130482+00:00", "manually_created": false, "acc": 0.2719615477041499, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45784, "user": "wish", "cui": "C0009241", "value": "deficits", "start": 2773, "end": 2781, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:46.237451+00:00", "manually_created": false, "acc": 0.35143796050562426, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45785, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2292, "end": 2299, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:40.180699+00:00", "manually_created": false, "acc": 0.4478733338875574, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45786, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 3674, "end": 3681, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:20:51.522729+00:00", "manually_created": false, "acc": 0.26434670882398226, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3241, "name": "496", "text": "REASON FOR CONSULTATION: , Lethargy.,HISTORY OF PRESENT ILLNESS:,  The patient is a 62-year-old white female with a past medical history of left frontal glioblastoma with subsequent craniotomy infection for PE, DVT, hyperlipidemia, and hypertension who is according to the patient's daughter expressing signs of depression.  Symptoms began on February 5, 2007, upon receiving the unexpected news, the patient would need three to four more days of chemotherapy and radiation therapy for her glioblastoma, described as a sudden onset of symptoms including hypersomnia (18 to 20 hours per day), drastic decrease in energy level, anhedonia, feelings of hopelessness and helplessness, psychomotor retardation, and past history of suicidal ideations.  The patient's appetite is unknown since she had been fed by NG tube after being diagnosed with neuromuscular oropharyngeal dysphagia.  Prior to receiving the news for needing more cancer therapy, the patient was described as being \"fine,\" participating in physical therapy and talking regularly as she was looking forward to leaving the hospital.  Now, the patient has become angry, socially withdrawn, not wanting to see anyone including her own grandchildren, and not participating in physical therapy.  Has been on a daily dose of Lexapro since January 08, 2007, was increased from 10 mg to 20 mg on January 24, 2007, which is her current dose.  Has been on Provigil 100 mg b.i.d. since February 06, 2007, but has not noticed an impact.  Had been on Zyprexa 2.5 mg p.o. q.p.m. from December 20, 2006, to February 01, 2007, but has been discontinued.  Currently, the patient has not displayed any manic symptoms, auditory or visual hallucinations, or symptoms of anxiety.  Also, denies any homicidal ideations.,PAST PSYCHIATRIC HISTORY:,  Was prescribed Prozac for depression, felt during husband's successful battle with prostate cancer.  Never been diagnosed with psychiatric illness.  Displayed some psychotic symptoms, status post craniotomy while in ICU, treated with Zyprexa and Xanax during hospitalization in 2006.,PAST MEDICAL HISTORY:,  Craniotomy November 2006 with subsequent CSF infection of enterobacter, status post glioblastoma multiforme, PE, DVT, hypertension, SIADH, and IVC filter.  No history of thyroid problems, seizures, strokes, or traumatic head injuries.,HOME MEDICATIONS:,  Norvasc 5 mg daily, TriCor 145 mg daily, aspirin one tablet daily, Tylenol, and glucosamine chondroitin sulfate.,CURRENT MEDICATIONS:,  Norvasc 10 mg p.o. daily, Decadron injection 6 mg IV q.12h., Colace 100 mg liquid b.i.d., Cardura 2 mg p.o. daily, Lexapro 20 mg p.o. daily, Lopressor 50 mg p.o. q.12h., Flagyl 500 mg via PEG tube q.8h., modafinil 100 mg p.o. b.i.d., Lovenox 60 mg subcu q.12h., insulin sliding scale, Tylenol suppositories 650 mg rectal q.4h. p.r.n., and Ambien 5 mg p.o. q.h.s. p.r.n.,ALLERGIES:,  PHENYTOIN (STEVENS-JOHNSON SYNDROME), CODEINE, NOVOCAIN, UNKNOWN ALLERGY.,FAMILY MEDICAL HISTORY:,  Father had lung cancer, was smoker for 40 years.  Father's aunt have heart disease.,SOCIAL AND DEVELOPMENTAL HISTORY:,  Currently lives with husband of 40 years in League City, has a Masters in Education, is a retired reading specialist which she did it for 33 years.  Has one younger brother, one daughter.  Denies use of tobacco, alcohol and illicit drugs.  The child as per daughter was picked on and has a strained relationship with her mother, but they still are communicating.,MENTAL STATUS EXAMINATION:,  The patient is a 62-year-old white female, lying in hospital bed, with gown on, eyes closed, short shaven hair, and golf ball-sized indentation in the anterior fontanelle from craniotomy.  Psychomotor retardation, poor eye contact, speech low volume, slow rate, poor flexion, essentially unresponsive, and somnolent during interview.  Poor concentration, mood unknown (the patient did not respond to questions), affect flat, thought process logical and goal directed, thought content unable to assess from the patient but the patient's daughter denied delusions and homicidal ideations.  Positive for passive suicidal ideations and perceptions.  No auditory or visual hallucinations.  Sensorium stuporous, did not answer orientation questions.  Memory information, intelligence, judgment, and insight unknown.,Mini-Mental status examination unable to be performed.,ASSESSMENT:,  A 62-year-old white female status post craniotomy for glioblastoma multiforme with subsequent CNS infection and currently has been displaying symptoms of depression for the past seven days and hence was told she needed more chemotherapy and radiation therapy.,Axis I:  Depression, NOS.  Rule out depression secondary to general medical condition.,Axis II:  Deferred.,Axis III:  Craniotomy with subsequent CSF infection, PE, DVT, and hypertension.,Axis IV:  Hospitalization.,Axis V:  11.,PLAN:,  Continue Lexapro 20 mg p.o. daily.  Discontinue Provigil, begin Ritalin 5 mg p.o. q.a.m. and q. noon.,Thank you for the consultation.", "last_modified": "2020-03-29 14:43:25.559149+00:00", "annotations": [{"id": 45787, "user": "wish", "cui": "C1404970", "value": "psychiatric illness", "start": 1914, "end": 1933, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:56.165118+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45788, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 216, "end": 230, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:13.845209+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45789, "user": "wish", "cui": "C0018524", "value": "hallucinations", "start": 1680, "end": 1694, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:37.554388+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45790, "user": "wish", "cui": "C0018524", "value": "hallucinations", "start": 4149, "end": 4163, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:28.916537+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45791, "user": "wish", "cui": "C0018799", "value": "heart disease", "start": 3038, "end": 3051, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:19.231130+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45792, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 236, "end": 248, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:17.987517+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45793, "user": "wish", "cui": "C0150063", "value": "helplessness", "start": 666, "end": 678, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:29.610130+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45794, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 2213, "end": 2225, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:03.858547+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45795, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 4793, "end": 4805, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:50.387476+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45796, "user": "wish", "cui": "C0917799", "value": "hypersomnia", "start": 554, "end": 565, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:24.544608+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45797, "user": "wish", "cui": "C0011570", "value": "depression", "start": 312, "end": 322, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:22.703919+00:00", "manually_created": false, "acc": 0.5165020325664718, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45798, "user": "wish", "cui": "C0011570", "value": "depression", "start": 1813, "end": 1823, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:42.375968+00:00", "manually_created": false, "acc": 0.5507493316211816, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45799, "user": "wish", "cui": "C0011570", "value": "depression", "start": 4514, "end": 4524, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:35.162231+00:00", "manually_created": false, "acc": 0.5779225858636157, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45800, "user": "wish", "cui": "C0011570", "value": "Depression", "start": 4629, "end": 4639, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:37.632975+00:00", "manually_created": false, "acc": 0.5847671334341074, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45801, "user": "wish", "cui": "C0011570", "value": "depression", "start": 4656, "end": 4666, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:38.646477+00:00", "manually_created": false, "acc": 0.4695725886736396, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45802, "user": "wish", "cui": "C0178417", "value": "anhedonia", "start": 626, "end": 635, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:27.511548+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45803, "user": "wish", "cui": "C0011168", "value": "dysphagia", "start": 869, "end": 878, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:35.229925+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45804, "user": "wish", "cui": "C0033975", "value": "psychotic", "start": 1951, "end": 1960, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:58.359919+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45805, "user": "wish", "cui": "C0011253", "value": "delusions", "start": 4033, "end": 4042, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:25.695077+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45806, "user": "wish", "cui": "C0012634", "value": "condition", "start": 4696, "end": 4705, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:22:47.236868+00:00", "manually_created": false, "acc": 0.31550858507181684, "meta_anns": []}, {"id": 45807, "user": "wish", "cui": "C0039082", "value": "SYNDROME", "start": 2896, "end": 2904, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:22:18.021918+00:00", "manually_created": false, "acc": 0.35811614250560736, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45808, "user": "wish", "cui": "C0038454", "value": "strokes", "start": 2293, "end": 2300, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:07.591251+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45809, "user": "wish", "cui": "C0028754", "value": "general", "start": 4680, "end": 4687, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:22:44.948903+00:00", "manually_created": false, "acc": 0.32203519521482893, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45810, "user": "wish", "cui": "C1407863", "value": "battle", "start": 1858, "end": 1864, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:21:53.204694+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45811, "user": "wish", "cui": "C4061796", "value": "MENTAL", "start": 3452, "end": 3458, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:22:24.488864+00:00", "manually_created": false, "acc": 0.46819696691659085, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45812, "user": "wish", "cui": "C4061796", "value": "Mental", "start": 4296, "end": 4302, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:22:33.994708+00:00", "manually_created": false, "acc": 0.29115748544020903, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45813, "user": "wish", "cui": "C0149871", "value": "DVT", "start": 211, "end": 214, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:12.809015+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45814, "user": "wish", "cui": "C0149871", "value": "DVT", "start": 2208, "end": 2211, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:03.332114+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45815, "user": "wish", "cui": "C0149871", "value": "DVT", "start": 4784, "end": 4787, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:49.813977+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45816, "user": "wish", "cui": "C0034065", "value": "PE", "start": 207, "end": 209, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:21:08.607010+00:00", "manually_created": false, "acc": 0.36654640918345577, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45817, "user": "wish", "cui": "C0018023", "value": "NG", "start": 806, "end": 808, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:21:33.593046+00:00", "manually_created": false, "acc": 0.2794287122979977, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45818, "user": "wish", "cui": "C0034065", "value": "PE", "start": 2204, "end": 2206, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:00.544222+00:00", "manually_created": false, "acc": 0.4018783339547625, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45819, "user": "wish", "cui": "C0034065", "value": "PE", "start": 4780, "end": 4782, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:22:49.078857+00:00", "manually_created": false, "acc": 0.30016196175472076, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3242, "name": "1070", "text": "Chief Complaint:, Abdominal pain, nausea and vomiting.,History of Present Illness:, A 50-year-old Asian female comes to The Methodist Hospital on January 2, 2001, complaining of a 3-day history of abdominal pain. The pain is described as crampy in the central part of her abdomen, and is associated with nausea and vomiting during the previous 24 hours. The patient denied passing any stool or gas per rectum for the previous 24 hours. She had been admitted recently to the hospital from December 19 to December 23, 2000, with a three-week history of fevers to 101.8, diaphoresis, anorexia, malaise and skin \"lumps\". She described a total of three \"lumps\". The first one started as a pin-sized lesion that grew up and then disappeared, the other two didn't resolve. They were described as \"erythematous nodular lesions on the extensor surface of the left arm.\" A punch biopsy was obtained from these skin lesions, showing deep dermis and subcutaneous adipose tissue that contained \"multiple granulomas composed of histiocytes and multinucleated giant cells without caseating necrosis\". However, one granuloma in the deep dermis, showed a hint of central necrosis. Special stains for acid - fast bacilli and fungi were reported as negative. No atypia or malignancy was noted. A CT scan of the chest was obtained on December 19, 2000 and showed numerous masses with spiculated borders bilaterally, predominately in the upper lobes and superior segments of the lower lobes. No cavitary lesions, mediastinal masses or definite hilar adenopathy were reported. The patient underwent bronchoscopy and transbronchial biopsy which showed fragments of bronchial mucosa and wall with underlying lung parenchyma. Minimal to mild interstitial lymphocytes with a few microfoci of neutrophils were seen. They were also able to appreciate intra-alveolar fibrinous exudates. One of the blood cultures drawn on December 19, 2000 grew Streptococcus mitis.,The patient was discharged on ethambutol 1200 mg po qd, clarithromycin 500 mg po bid, ampicillin 500 mg po q 6h and fluconazole 200 mg po qd.,Past Medical History:,1. Post-streptococcal glomerulonephritis at age 10.,2. End stage renal disease diagnosed in 1994, on peritoneal dialysis until 1996.,3. Cadaveric transplant in October 1996,4. Steroid induced diabetes mellitus,5. Hypertension,Past Surgical History:,1. Total abdominal hysterectomy in January 1996,2. Cesarean section X2 in 1996 and 1997,3. Appendectomy in 1971,4. Insertion of peritoneal dialysis catheter in 1994,5. Cadaveric transplant in October 1996,Social History:,The patient denies a history of smoking, drinking or intravenous drug use. She came to the United States in 1973. She works as a nurse in a newborn nursery. Her hobby is gardening. She traveled to Las Vegas on May 2000 and stayed for 6 months. She denied ill contacts or pets.,Allergies:, Ciprofloxacin and Enteric coated aspirin,Medications:, prednisone 20 mg po qd, enalapril 2.5 mg po qd, clonidine patch TTS 3 1/week, Prograf 5 mg po bid, ranitidine 150 mg po bid, furosemide 40 mg po bid, atorvastatin 10 mg po qd, multivitamins 1 tab po qd, estrogen patch, fluconazole 200 mg po qd, metformin 500 mg po bid, glyburide 10 mg po qd, clarithromycin 500 mg po bid, ethambutol 1200 mg po qd, ampicillin 500 mg po q 6h.,Family History:, She described a family history of hypertension. Her mother died after a myocardial infarction at age 59. Her father was diagnosed with congestive heart failure and had a pacemaker placed.,Review of systems:, Non-contributory. The patient denied fever, chills, ulcers, liver disease or history of gallstones.,Vaccines: The patient was vaccinated with BCG before starting elementary school in the Philippines.,Physical Examination:, At the time of the examination the patient was alert and oriented times three and in no acute distress. She was well nourished.,BP 106/60 lying down; HR 86; RR 12; T 96.1\u00b0 F; Hgt. =5' 2\"; Wgt. =121 lbs.,SKIN: There was no rash or skin lesions.,HEENT: She had no oral lesions and moist mucous membranes. No icterus was noted.,NECK: Her neck was supple without lymphadenopathy or thyromegaly.,LUNGS: Crackles at the right lower base with normal respiratory excursion and no dullness to percussion.,HEART: IV/VI crescendo - decrescendo systolic murmur was heard at the second intercostal space with radiation to the neck.,ABDOMEN: The abdomen was distended. Bowel sounds were normal. No hepatosplenomegaly, tenderness or rebound tenderness could be detected during the examination.,EXTREMITIES: No cyanosis, clubbing or edema was noted.,RECTAL: Normal rectal exam. Guaiac negative.,NEUROLOGIC: Normal and non-focal.,Hospital Course:,  The patient was admitted and a nasogastric tube was placed. IV fluids were started. A KUB was obtained showing an abnormal bowel gas pattern. Multiple loops of distended bowel were noted in the mid abdomen. Air and feces were noted within the colon in the right side. An Abdominal CT scan was obtained. There was a small amount of perihepatic fluid noted. The liver and spleen were normal. The kidneys were atrophic. The gallbladder was moderately distended. There was marked dilatation of the small bowel proximally and distally. There was gas and contrast material in the colon. A diagnostic procedure was performed.", "last_modified": "2020-03-29 14:43:25.559717+00:00", "annotations": [{"id": 45820, "user": "wish", "cui": "C0018802", "value": "congestive heart failure", "start": 3443, "end": 3467, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:40.242615+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45821, "user": "wish", "cui": "C0022661", "value": "End stage renal disease", "start": 2156, "end": 2179, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:20.081601+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45822, "user": "wish", "cui": "C0027051", "value": "myocardial infarction", "start": 3380, "end": 3401, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:37.864862+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45823, "user": "wish", "cui": "C0017658", "value": "glomerulonephritis", "start": 2123, "end": 2141, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:16.487983+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45824, "user": "wish", "cui": "C0011849", "value": "diabetes mellitus", "start": 2293, "end": 2310, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:21.652082+00:00", "manually_created": false, "acc": 0.44149476293652234, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45825, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 4098, "end": 4113, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:55.206439+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45826, "user": "wish", "cui": "C0023895", "value": "liver disease", "start": 3576, "end": 3589, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:48.176838+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45827, "user": "wish", "cui": "C0037284", "value": "skin lesions", "start": 900, "end": 912, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:09.045612+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45828, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 2314, "end": 2326, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:24.467109+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45829, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 3342, "end": 3354, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:31.526228+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45830, "user": "wish", "cui": "C0037284", "value": "skin lesions", "start": 3969, "end": 3981, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:50.133408+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45831, "user": "wish", "cui": "C0041834", "value": "erythematous", "start": 790, "end": 802, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:02.779010+00:00", "manually_created": false, "acc": 0.47943951972754273, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45832, "user": "wish", "cui": "C0003123", "value": "anorexia", "start": 581, "end": 589, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:00.433787+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45833, "user": "wish", "cui": "C0242510", "value": "drug use", "start": 2636, "end": 2644, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:27.598664+00:00", "manually_created": false, "acc": 0.5577006518635477, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45834, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 4006, "end": 4013, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:52.851012+00:00", "manually_created": false, "acc": 0.522310434958107, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45835, "user": "wish", "cui": "C0041582", "value": "ulcers", "start": 3568, "end": 3574, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:23:44.192785+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45836, "user": "wish", "cui": "C0004930", "value": "punch", "start": 863, "end": 868, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:23:07.897484+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45837, "user": "wish", "cui": "C0017547", "value": "giant", "start": 1045, "end": 1050, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:23:15.081906+00:00", "manually_created": false, "acc": 0.3583975177658868, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45838, "user": "wish", "cui": "C0018799", "value": "HEART", "start": 4235, "end": 4240, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:23:59.866647+00:00", "manually_created": false, "acc": 0.2272820937478998, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3243, "name": "611", "text": "CHIEF COMPLAINT: , Penile discharge, infected-looking glans.,HISTORY OF PRESENT ILLNESS: , The patient is a 67-year-old African-American male, who was recently discharged from the hospital on July 21, 2008 after being admitted for altered mental status and before that after undergoing right above knee amputation for wet gangrene.  The patient was transferred to Nursing Home and presents today from the nursing home with complaints of bleeding from the right AKA stump and penile discharge.  As per the patient during his hospitalizations over here, he had indwelling Foley catheter for a few days and when he was discharged at the nursing home he was discharged without the catheter.  However, the patient was brought back to the ED today when he suffered fall yesterday and started bleeding from his stump.  While placing the catheter in the ED on retraction of foreskin purulent discharge was seen from the penis and the glans appeared infected, so urology consult was placed.,REVIEW OF SYSTEMS: , Negative except as in the HPI.,PAST MEDICAL HISTORY: , Significant for end-stage renal disease on dialysis, hypertension, peripheral vascular disease, coronary artery disease, congestive heart failure, diabetes, and hyperlipidemia.,PAST SURGICAL HISTORY:  ,Right AKA,MEDICATIONS:,  Novolin, Afrin, Nephro-Vite, Neurontin, lisinopril, furosemide, Tums, labetolol, Plavix, nitroglycerin, Aricept, omeprazole, oxycodone, Norvasc, Renagel, and morphine.,ALLERGIES: , PENICILLIN and ADHESIVE TAPE.,FAMILY HISTORY: , Significant for hypertension, hyperlipidemia, diabetes, chronic renal insufficiency, and myocardial infarction.,SOCIAL HISTORY: , The patient lives alone.  He is unemployed, disabled.  He has history of tobacco use in the past.  He denies alcohol or drug abuse.,PHYSICAL EXAMINATION:,GENERAL:  A well-appearing African-American male lying comfortably in bed, in acute distress.,NECK:  Supple.,LUNGS:  Clear to auscultation bilaterally.,CARDIOVASCULAR:  S1 and S2, normal.,ABDOMEN:  Soft, nondistended, and nontender.,GENITOURINARY:  Penis is not circumcised.  Currently, indwelling Foley catheter in place.  On retraction of the foreskin, pale-looking glans tip with areas of yellow-white tissue.  The proximal glans appeared pink.  The patient currently has indwelling Foley catheter and glans slightly tender to touch.  However, no purulent discharge was seen on compression of the glans.  Otherwise on palpation, no other deformity noticed.  Bilateral testes descended.  No palpable abnormality.  No evidence of infection in his perineal area.,EXTREMITIES:  Right AKA.,NEUROLOGIC:  Awake, alert, and oriented.  No sensory or motor deficit.,LABORATORY DATA: , I independently reviewed the lab work done on the patient.  The patient had a UA done in the ED which showed few bacteria, white blood cells 6 to 12, and a few epithelial cells which were negative.  His basic metabolic panel with creatinine of 7.2 and potassium of 5, otherwise normal.  CBC with a white blood cell count of 11.5, hemoglobin of 9.5, and INR of 1.13.,IMPRESSION: , A 67-year-old male with multiple comorbidities with penile discharge and pale-appearing glans.  It seems that the patient has had multiple catheterizations recently and has history of peripheral vascular disease.  I think it is due to chronic ischemic changes.,RECOMMENDATIONS: , Our recommendation would be:,1.  To remove the Foley catheter.,2.  Local hygiene.,3.  Local application of bacitracin ointment.,4.  Antibiotic for urinary tract infection.,5.  Follow up as needed.  Of note, it was explained to the patient that the appearance of this glans may improve or may get worsened but at this point, there is no indication to operate on him.  If increased purulent discharge, the patient was asked to call us sooner, otherwise follow up as scheduled.", "last_modified": "2020-03-29 14:43:25.560286+00:00", "annotations": [{"id": 45839, "user": "wish", "cui": "C0085096", "value": "peripheral vascular disease", "start": 1125, "end": 1152, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:20.421354+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45840, "user": "wish", "cui": "C0403447", "value": "chronic renal insufficiency", "start": 1570, "end": 1597, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:26.636492+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45841, "user": "wish", "cui": "C0085096", "value": "peripheral vascular disease", "start": 3240, "end": 3267, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:38.444892+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45842, "user": "wish", "cui": "C0018802", "value": "congestive heart failure", "start": 1179, "end": 1203, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:21.977386+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45843, "user": "wish", "cui": "C0022661", "value": "end-stage renal disease", "start": 1074, "end": 1097, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:18.476337+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45844, "user": "wish", "cui": "C0042029", "value": "urinary tract infection", "start": 3483, "end": 3506, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:49.609452+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45845, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 1154, "end": 1177, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:21.269275+00:00", "manually_created": false, "acc": 0.5117776607435819, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45846, "user": "wish", "cui": "C0027051", "value": "myocardial infarction", "start": 1603, "end": 1624, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:27.502380+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45847, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 1219, "end": 1233, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:23.423293+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45848, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 1544, "end": 1558, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:25.425785+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45849, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1111, "end": 1123, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:19.541185+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45850, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1530, "end": 1542, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:24.393425+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45851, "user": "wish", "cui": "C0013146", "value": "drug abuse", "start": 1764, "end": 1774, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:28.220310+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45852, "user": "wish", "cui": "C0854135", "value": "infection", "start": 2529, "end": 2538, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:31.011807+00:00", "manually_created": false, "acc": 0.4940431088066718, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45853, "user": "wish", "cui": "C2363741", "value": "infected", "start": 37, "end": 45, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:12.338238+00:00", "manually_created": false, "acc": 0.30566485001790056, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45854, "user": "wish", "cui": "C0683278", "value": "suffered", "start": 750, "end": 758, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:24:17.362790+00:00", "manually_created": false, "acc": 0.3883542914371241, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45855, "user": "wish", "cui": "C0011849", "value": "diabetes", "start": 1205, "end": 1213, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:22.700121+00:00", "manually_created": false, "acc": 0.5401535154235131, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45856, "user": "wish", "cui": "C0011849", "value": "diabetes", "start": 1560, "end": 1568, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:24:26.107056+00:00", "manually_created": false, "acc": 0.5895813513203143, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45857, "user": "wish", "cui": "C0008679", "value": "chronic", "start": 3291, "end": 3298, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:24:48.213415+00:00", "manually_created": false, "acc": 0.48231332453038595, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3259, "name": "688", "text": "HISTORY OF PRESENT ILLNESS:,  The patient is a 63-year-old white male who was admitted to the hospital with CHF and lymphedema.  He also has a history of obesity, hypertension, sleep apnea, chronic low back pain, cataracts, and past history of CA of the lung.  This consultation was made for better control of his blood sugars.  On questioning, the patient says that he does not have diabetes.  He says that he has never been told about diabetes except during his last admission at Jefferson Hospital.  Apparently, he was started on glipizide at that time.  His blood sugars since then have been good and he says when he went back to Jefferson three weeks later, he was told that he does not have a sugar problem.  He is not sure.  He is not following any specific diet.  He says \"my doctor wants me to lose 30-40 pounds in weight\" and he would not mind going on a diet.  He has a long history of numbness of his toes.  He denies any visual problems.,PAST MEDICAL HISTORY: , As above that includes CA of the lung, COPD, bilateral cataracts.  He has had chronic back pain.  There is also a history of bilateral hip surgeries, penile implant and removal, umbilical hernia repair, and back pain with two surgeries with details of which are unknown.,SOCIAL HISTORY: , The patient has been a smoker since the age of 10.  So, he was smoking 2-3 packs per day.  Since being started on Chantix, he says he has cut it down to half a pack per day.  He does not abuse alcohol.,MEDICATIONS: ,1.  Glipizide 5 mg p.o. daily.,2.  Theophylline.,3.  Z-Pak.,4.  Chantix.,5.  Januvia 100 mg daily.,6.  K-Lor.,7.  OxyContin.,8.  Flomax.,9.  Lasix.,10.  Advair.,11.  Avapro.,12.  Albuterol sulfate.,13.  Vitamin B tablet.,14.  OxyContin and oxycodone for pain.,FAMILY HISTORY: , Positive for diabetes mellitus in the maternal grandmother.,REVIEW OF SYSTEMS: , As above.  He says he has had numbness of toes for a long time.  He denies any visual problems.  His legs have been swelling up from time to time for a long time.  He also has history of COPD and gets short of breath with minimal activity.  He is also not able to walk due to his weight.  He has had ulcers on his legs, which he gets discharge from.  He has chronic back pain and takes OxyContin.  He denies any constipation, diarrhea, abdominal pain, nausea or vomiting.  There is no chest pain.  He does get short of breath on walking.,PHYSICAL EXAMINATION:,The patient is a well-built, obese, white male in no acute distress.,Vital signs:  Pulse rate of 89 per minute and regular.  Blood pressure of 113/69, temperature is 98.4 degrees Fahrenheit, and respirations are 18.,HEENT:  Head is normocephalic and atraumatic.  Eyes, PERRLA.  EOMs intact.  Fundi were not examined.,Neck:  Supple.  JVP is low.  Trachea central.  Thyroid small in size.  No carotid bruits.,Heart:  Shows normal sinus rhythm with S1 and S2.,Lungs:  Show bilateral wheezes with decreased breath sounds at the bases.,Abdomen:  Soft and obese.  No masses.  Bowel sounds are present.,Extremities:  Show bilateral edema with changes of chronic venostasis.  He does have some open weeping sores.  Pulses could not be palpated due to leg swelling.,IMPRESSION/PLAN:,1.  Diabetes mellitus, type 2, new onset.  At this time, the patient is on Januvia as well as glipizide.  His blood sugar right after eating his supper was 101.  So, I am going to discontinue glipizide, continue on Januvia, and add no-concentrated sweets to the diet.  We will continue to follow his blood sugars closely and make adjustments as needed.,2.  Neuropathy, peripheral, query etiology.  We will check TSH and B12 levels.,3.  Lymphedema.,4.  Recurrent cellulitis.,5.  Obesity, morbid.,6.  Tobacco abuse.  He was encouraged to cut his cigarettes down to 5 cigarettes a day.  He says he feels like smoking after meals.  So, we will let him have it after meals first thing in the morning and last thing at night.,7.  Chronic venostasis.,8.  Lymphedema.  We would check his lipid profile also.,9.  Hypertension.,10.  Backbone pain, status post back surgery.,11.  Status post hernia repair.,12.  Status post penile implant and removal.,13.  Umbilical hernia repair.", "last_modified": "2020-03-29 14:43:25.568977+00:00", "annotations": [{"id": 45868, "user": "wish", "cui": "C0011860", "value": "Diabetes mellitus, type 2", "start": 3177, "end": 3202, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:50.483883+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45869, "user": "wish", "cui": "C0457949", "value": "chronic low back pain", "start": 190, "end": 211, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:23.463454+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45870, "user": "wish", "cui": "C0011854", "value": "diabetes mellitus", "start": 1771, "end": 1788, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:43.250137+00:00", "manually_created": false, "acc": 0.507759796770088, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45871, "user": "wish", "cui": "C0040336", "value": "Tobacco abuse", "start": 3672, "end": 3685, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:00.039617+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45872, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 163, "end": 175, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:22.200789+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45873, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 3977, "end": 3989, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:02.405244+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45874, "user": "wish", "cui": "C0037315", "value": "sleep apnea", "start": 177, "end": 188, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:22.770427+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45875, "user": "wish", "cui": "C0024236", "value": "lymphedema", "start": 116, "end": 126, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:20.450448+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45876, "user": "wish", "cui": "C0442874", "value": "Neuropathy", "start": 3530, "end": 3540, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:52.113151+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45877, "user": "wish", "cui": "C0024236", "value": "Lymphedema", "start": 3609, "end": 3619, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:57.921399+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45878, "user": "wish", "cui": "C0024236", "value": "Lymphedema", "start": 3921, "end": 3931, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:01.244730+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45879, "user": "wish", "cui": "C0270922", "value": "peripheral", "start": 3542, "end": 3552, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:26:56.603388+00:00", "manually_created": false, "acc": 0.20034677013661278, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45880, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 384, "end": 392, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:24.129009+00:00", "manually_created": false, "acc": 0.6055858234438938, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45881, "user": "wish", "cui": "C0011854", "value": "diabetes", "start": 437, "end": 445, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:29.365811+00:00", "manually_created": false, "acc": 0.6202033469505861, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45882, "user": "wish", "cui": "C0028754", "value": "obesity", "start": 154, "end": 161, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:21.175812+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45883, "user": "wish", "cui": "C0028754", "value": "Obesity", "start": 3651, "end": 3658, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:58.981064+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45884, "user": "wish", "cui": "C0041582", "value": "ulcers", "start": 2139, "end": 2145, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:47.354579+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45885, "user": "wish", "cui": "C0013146", "value": "abuse", "start": 1451, "end": 1456, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:26:42.165826+00:00", "manually_created": false, "acc": 0.44885219751303473, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45886, "user": "wish", "cui": "C0028754", "value": "obese", "start": 2428, "end": 2433, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:48.437168+00:00", "manually_created": false, "acc": 0.21882414332755024, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45887, "user": "wish", "cui": "C0024117", "value": "COPD", "start": 1014, "end": 1018, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:31.921397+00:00", "manually_created": false, "acc": 0.2908101132297537, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45888, "user": "wish", "cui": "C0024117", "value": "COPD", "start": 2026, "end": 2030, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:45.260185+00:00", "manually_created": false, "acc": 0.33661067727540417, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45889, "user": "wish", "cui": "C0018802", "value": "CHF", "start": 108, "end": 111, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:26:15.934779+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3260, "name": "73", "text": "HISTORY OF PRESENT ILLNESS:,  This 57-year-old black female was seen in my office on Month DD, YYYY for further evaluation and management of hypertension.  Patient has severe backache secondary to disc herniation.  Patient has seen an orthopedic doctor and is scheduled for surgery.  Patient also came to my office for surgical clearance.  Patient had cardiac cath approximately four years ago, which was essentially normal.  Patient is documented to have morbid obesity and obstructive sleep apnea syndrome.  Patient does not use a CPAP mask.  Her exercise tolerance is eight to ten feet for shortness of breath.  Patient also has two-pillow orthopnea.  She has intermittent pedal edema.,PHYSICAL EXAMINATION:  ,VITAL SIGNS:  Blood pressure is 135/70.  Respirations 18 per minute.  Heart rate 70 beats per minute.  Weight 258 pounds.,HEENT:  Head normocephalic.  Eyes, no evidence of anemia or jaundice.  Oral hygiene is good. ,NECK:  Supple.  JVP is flat.  Carotid upstroke is good. ,LUNGS:  Clear. ,CARDIOVASCULAR:  There is no murmur or gallop heard over the precordium. ,ABDOMEN:  Soft.  There is no hepatosplenomegaly. ,EXTREMITIES:  The patient has no pedal edema.  ,MEDICATIONS:  ,1.  BuSpar 50 mg daily.,2.  Diovan 320/12.5 daily.,3.  Lotrel 10/20 daily.,4.  Zetia 10 mg daily.,5.  Ambien 10 mg at bedtime.,6.  Fosamax 70 mg weekly.,DIAGNOSES:,1.  Controlled hypertension.,2.  Morbid obesity.,3.  Osteoarthritis.,4.  Obstructive sleep apnea syndrome.,5.  Normal coronary arteriogram.,6.  Severe backache.,PLAN:,1.  Echocardiogram, stress test.,2  Routine blood tests.,3.  Sleep apnea study.,4.  Patient will be seen again in my office in two weeks.", "last_modified": "2020-03-29 14:43:25.569498+00:00", "annotations": [{"id": 45890, "user": "wish", "cui": "C0520679", "value": "obstructive sleep apnea syndrome", "start": 475, "end": 507, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:16.011551+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45891, "user": "wish", "cui": "C0520679", "value": "Obstructive sleep apnea syndrome", "start": 1426, "end": 1458, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:27.551163+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45892, "user": "wish", "cui": "C0028756", "value": "morbid obesity", "start": 456, "end": 470, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:13.625351+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45893, "user": "wish", "cui": "C0028756", "value": "Morbid obesity", "start": 1386, "end": 1400, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:26.284385+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45894, "user": "wish", "cui": "C0029408", "value": "Osteoarthritis", "start": 1406, "end": 1420, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:27.016348+00:00", "manually_created": false, "acc": 0.41876123881421157, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45895, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 141, "end": 153, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:10.159147+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45896, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1368, "end": 1380, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:24.541116+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45897, "user": "wish", "cui": "C0037315", "value": "Sleep apnea", "start": 1581, "end": 1592, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:28.270116+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45898, "user": "wish", "cui": "C0002871", "value": "anemia", "start": 885, "end": 891, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:21.872010+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3261, "name": "323", "text": "CHIEF COMPLAINT:,  The patient is here for two-month followup.,HISTORY OF PRESENT ILLNESS:,  The patient is a 55-year-old Caucasian female.  She has hypertension.  She has had no difficulties with chest pain.  She has some shortness of breath only at walking up the stairs.  She has occasional lightheadedness only if she bends over then stands up quickly.  She has had no nausea, vomiting, or diarrhea.  She does have severe osteoarthritis of the left knee and is likely going to undergo total knee replacement with Dr. XYZ in January of this coming year.  The patient is wanting to lose weight before her surgery.  She is concerned about possible coronary disease or stroke risk.  She has not had any symptoms of cardiac disease other than some shortness of breath with exertion, which she states has been fairly stable.  She has had fairly normal lipid panel, last being checked on 11/26/2003.  Cholesterol was 194, triglycerides 118, HDL 41, and LDL 129.  The patient is a nonsmoker.  Her fasting glucose in November 2003 was within normal limits at 94.  Her fasting insulin level was normal.  Repeat nonfasting glucose was 109 on 06/22/2004.  She does not have history of diabetes.  She does not exercise regularly and is not able to because of knee pain.  She also has had difficulties with low back pain.  X-ray of the low back did show a mild compression fracture of L1.  She has had no falls that would contribute to a compression fracture.  She has had a normal DEXA scan on 11/07/2003 that does not really correlate with having a compression fracture of the lumbar spine; however, it is possible that arthritis could contribute to falsely high bone density reading on DEXA scan.  She is wanting to consider treatment for prevention of further compression fractures and possible osteoporosis.,CURRENT MEDICATIONS:,  Hydrochlorothiazide 12.5 mg a day, Prozac 20 mg a day, Vioxx 25 mg a day, vitamin C 250 mg daily, vitamin E three to four tablets daily, calcium with D 1500 mg daily, multivitamin daily, aspirin 81 mg daily, Monopril 40 mg daily, Celexa p.r.n.,ALLERGIES:  ,Bactrim, which causes nausea and vomiting, and adhesive tape.,PAST MEDICAL HISTORY:,1.  Hypertension.,2.  Depression.,3.  Myofascitis of the feet.,4.  Severe osteoarthritis of the knee.,5.  Removal of the melanoma from the right thigh in 1984.,6.  Breast biopsy in January of 1997, which was benign.,7.  History of Holter monitor showing ectopic beat.  Echocardiogram was normal.  These were in 1998.,8.  Compression fracture of L1, unknown cause.  She had had no injury.  Interestingly, DEXA scan was normal 11/07/2003, which is somewhat conflicting.,SOCIAL HISTORY:,  The patient is married.  She is a nonsmoker and nondrinker.,REVIEW OF SYSTEMS:,  As per the HPI.,PHYSICAL EXAMINATION:,General:  This is a well-developed, well-nourished, pleasant Caucasian female, who is overweight.,Vital signs:  Weight:  Refused.  Blood pressure:  148/82, on recheck by myself with a large cuff, it was 125/60.  Pulse:  64.  Respirations:  20.  Temperature:  96.3.,Neck:  Supple.  Carotids are silent.,Chest:  Clear to auscultation.,Cardiovascular:  Revealed a regular rate and rhythm without murmur, S3, or S4.,Extremities:  Revealed no edema.,Neurologic:  Grossly intact.,RADIOLOGY:  EKG revealed normal sinus rhythm, rate 61, borderline first degree AV block, and poor R-wave progression in the anterior leads.,ASSESSMENT:,1.  Hypertension, well controlled.,2.  Family history of cerebrovascular accident.,3.  Compression fracture of L1, mild.,4.  Osteoarthritis of the knee.,5.  Mildly abnormal chest x-ray.,PLAN:,1.  We will get a C-reactive protein cardiac.,2.  We discussed weight loss options.  I would recommend Weight Watchers or possibly having her see a dietician.  She will think about these options.  She is not able to exercise regularly right now because of knee pain.,3.  We would recommend a screening colonoscopy.  She states that we discussed this in the past and she canceled her appointment to have that done.  She will go ahead and make an appointment to see Dr. XYZ for screening colonoscopy.,4.  We will start Fosamax 70 mg once weekly.  She is to take this in the morning on an empty stomach with full glass of water.  She is not to eat, lie down, or take other medications for at least 30 minutes after taking Fosamax.,5.  I would like to see her back in one to two months.  At that time, we can do preoperative evaluation and we will probably send her to a cardiologist because of mildly abnormal EKG for preoperative cardiac testing.  One would also consider preoperative beta-blocker for cardiac protection.", "last_modified": "2020-03-29 14:43:25.570040+00:00", "annotations": [{"id": 45899, "user": "wish", "cui": "C0409959", "value": "osteoarthritis of the knee", "start": 2241, "end": 2267, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:28.648653+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45900, "user": "wish", "cui": "C0409959", "value": "Osteoarthritis of the knee", "start": 3523, "end": 3549, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:36.296025+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45901, "user": "wish", "cui": "C0010054", "value": "coronary disease", "start": 649, "end": 665, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:38.241561+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45902, "user": "wish", "cui": "C0018799", "value": "cardiac disease", "start": 715, "end": 730, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:46.024431+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45903, "user": "wish", "cui": "C0029408", "value": "osteoarthritis", "start": 426, "end": 440, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:37.040592+00:00", "manually_created": false, "acc": 0.5742284350319431, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45904, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 149, "end": 161, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:35.916231+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45905, "user": "wish", "cui": "C0029456", "value": "osteoporosis", "start": 1789, "end": 1801, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:56.105638+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45906, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 2171, "end": 2183, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:07.859700+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45907, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 3402, "end": 3414, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:35.289540+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45908, "user": "wish", "cui": "C0011570", "value": "Depression", "start": 2189, "end": 2199, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:09.079793+00:00", "manually_created": false, "acc": 0.6469596512622217, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45909, "user": "wish", "cui": "C1561826", "value": "overweight", "start": 2858, "end": 2868, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:30.070531+00:00", "manually_created": false, "acc": 0.395681443453883, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45910, "user": "wish", "cui": "C0003864", "value": "arthritis", "start": 1612, "end": 1621, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:52.254417+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45911, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 1177, "end": 1185, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:49.391903+00:00", "manually_created": false, "acc": 0.647106142491134, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45912, "user": "wish", "cui": "C0018801", "value": "cardiac", "start": 4590, "end": 4597, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:28:38.696859+00:00", "manually_created": false, "acc": 0.37745908225304, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45913, "user": "wish", "cui": "C3844825", "value": "stroke", "start": 669, "end": 675, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:27:43.614396+00:00", "manually_created": false, "acc": 0.5990868850475312, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45914, "user": "wish", "cui": "C0018794", "value": "block", "start": 3328, "end": 3333, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:28:34.020606+00:00", "manually_created": false, "acc": 0.35290558192865507, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3262, "name": "1737", "text": "CHIEF COMPLAINT:,  Vomiting and nausea.,HPI: , The patient is a 52-year-old female who said she has had 1 week of nausea and vomiting, which is moderate-to-severe.  She states she has it at least once a day.  It can be any time, but can also be postprandial.  She states she will vomit up some dark brown-to-green fluid.  There has been no hematemesis.  She states because of the nausea and vomiting, she has not been able to take much in the way of PO intake over the past week.  She states her appetite is poor.  The patient has lost 40 pounds of weight over the past 16 months.  She states for the past few days, she has been getting severe heartburn.  She used Tums over-the-counter and that did not help.  She denies having any dysphagia or odynophagia.  She is not having any abdominal pain.  She has no diarrhea, rectal bleeding, or melena.  She has had in the past, which was remote.  She did have some small amounts of rectal bleeding on the toilet tissue only if she passed a harder stool.  She has a history of chronic constipation for most of her life but she definitely has a bowel movement every 3 to 4 days and this is unchanged.  The patient states she has never had any endoscopy or barium studies of the GI tract.,The patient is anemic and her hemoglobin is 5.7 and she is thrombocytopenic with the platelet count of 34.  She states she has had these abnormalities since she has been diagnosed with breast cancer.  She states that she has metastatic breast cancer and that is in her rib cage and spine and she is getting hormonal chemotherapy for this and she is currently under the care of an oncologist.  The patient also has acute renal failure at this point.  The patient said she had a PET scan done about a week ago.,PAST MEDICAL HISTORY:,  Metastatic breast cancer to her rib cage and spine, hypothyroidism, anemia, thrombocytopenia, hypertension, Bells palsy, depression, uterine fibroids, hysterectomy, cholecystectomy, breast lumpectomy, and thyroidectomy.,ALLERGIES: , No known drug allergies.,MEDICINES:,  She is on Zofran, Protonix, fentanyl patch, Synthroid, Ativan, and Ambien.,SOCIAL HISTORY:  ,The patient is divorced and is a homemaker.  No smoking or alcohol.,FAMILY HISTORY:,  Negative for any colon cancer or polyps.  Her father died of mesothelioma, mother died of Hodgkin lymphoma.,SYSTEMS REVIEW: , No fevers, chills or sweats.  She has no chest pain, palpitations, coughing or wheezing.  She does get shortness of breath, no hematuria, dysuria, arthralgias, myalgias, rashes, jaundice, bleeding or clotting disorders.  The rest of the system review is negative as per the HPI.,PHYSICAL EXAM: , Temperature 98.4, blood pressure 95/63, heart rate 84, respiratory rate of 18, and weight is 108 kg.  GENERAL APPEARANCE:  The patient was comfortable in bed.  Skin exam is negative for any rashes or jaundice.  LYMPHATICS:  There is no palpable lymphadenopathy of the cervical or the supraclavicular area.  HEENT:  She has some mild ptosis of the right eye.  There is no icterus.  The patient's conjunctivae and sclerae are normal.  Pupils are equal, round, and reactive to light and accommodation.  No lesions of the oral mucosa or mucosa of the pharynx.  NECK:  Supple.  Carotids are 2+.  No thyromegaly, masses or adenopathy.  HEART:  Has regular rhythm.  Normal S1 and S2.  She has a 2/6 systolic ejection murmur.  No rubs or gallops.  Lungs are clear to percussion and auscultation.  Abdomen is obese, it may be mildly distended.  There is no increased tympany.  The patient does have hepatosplenomegaly.  There is no obvious evidence of ascites.  The abdomen is nontender, bowel sounds are present.  The extremities show some swelling and edema of the ankle regions bilaterally.  Legs are in SCDs.  No cyanosis or clubbing.  For the rectal exam, it shows brown stool that is very trace heme positive at most.  For the neuro exam, she is awake, alert, and oriented x3.  Memory intact.  No focal deficits.  Insight and judgment are intact.,X-RAY AND LABORATORY DATA:  ,She came in, white count 9.2, hemoglobin 7.2, hematocrit 22.2, MCV of 87, platelet count is 47,000.  Calcium is 8.1, sodium 134, potassium 5.3, chloride 102, bicarbonate 17, BUN of 69, creatinine of 5.2, albumin 2.2, ALT 28, bilirubin is 2.2, alkaline phosphatase is 359, AST is 96, and lipase is 30.  Today, her hemoglobin is 5.7, TSH is 1.1, platelet count is 34,000, alkaline phosphatase is 303, and bilirubin of 1.7.,IMPRESSION,1.  The patient has one week of nausea and vomiting with decreased p.o. intake as well as dehydration.  This could be on the basis of her renal failure.  She may have a viral gastritis.  The patient does have a lot of gastroesophageal reflux disease symptoms recently.  She could have peptic mucosal inflammation or peptic ulcer disease.,2.  The patient does have hepatosplenomegaly.  There is a possibility she could have liver metastasis from the breast cancer.,3.  She has anemia as well as thrombocytopenia.  The patient states this is chronic.,4.  A 40-pound weight loss.,5.  Metastatic breast cancer.,6.  Increased liver function tests.  Given her bone metastasis, the elevated alkaline phosphatase may be from this as opposed to underlying liver disease.,7.  Chronic constipation.,8.  Acute renal failure.,PLAN:  ,The patient will be on a clear liquid diet.  She will continue on the Zofran.  She will be on IV Protonix.  The patient is going to be transfused packed red blood cells and her hemoglobin and hematocrit will be monitored.  I obtained the result of the abdominal x-rays she had done through the ER.  The patient has a consult pending with the oncologist to see what her PET scan show.  There is a renal consult pending.  I am going to have her get a total abdominal ultrasound to see if there is any evidence of liver metastasis and also to assess her kidneys.  Her laboratory studies will be followed.  Based upon the patient's medical condition and including her laboratory studies including a platelet count, we talked about EGD versus upper GI workup per upper GI symptoms.  I discussed informed consent for EGD.  I discussed the indications, risks, benefits, and alternatives.  The risks reviewed included, but were not limited to an allergic reaction or side effect to medicines, cardiopulmonary complications, bleeding, infection, perforation, and needing to get admitted for antibiotics or blood transfusion or surgery.  The patient voices her understanding of the above.  She wants to think about what she wants to do.  Overall, this is a very ill patient with multiorgan involvement.", "last_modified": "2020-03-29 14:43:25.570542+00:00", "annotations": [{"id": 45915, "user": "wish", "cui": "C0017168", "value": "gastroesophageal reflux disease", "start": 4660, "end": 4691, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:00.605971+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45916, "user": "wish", "cui": "C0022660", "value": "acute renal failure", "start": 1646, "end": 1665, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:29:58.723340+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45917, "user": "wish", "cui": "C0022660", "value": "Acute renal failure", "start": 5234, "end": 5253, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:19.851708+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45918, "user": "wish", "cui": "C0005779", "value": "clotting disorders", "start": 2541, "end": 2559, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:30.405360+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45919, "user": "wish", "cui": "C0040034", "value": "thrombocytopenia", "start": 1841, "end": 1857, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:08.616081+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45920, "user": "wish", "cui": "C0040034", "value": "thrombocytopenia", "start": 4936, "end": 4952, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:16.490102+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45921, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 2882, "end": 2897, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:36.590262+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45922, "user": "wish", "cui": "C0020676", "value": "hypothyroidism", "start": 1817, "end": 1831, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:03.720247+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45923, "user": "wish", "cui": "C0035078", "value": "renal failure", "start": 4580, "end": 4593, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:51.950950+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45924, "user": "wish", "cui": "C0023895", "value": "liver disease", "start": 5189, "end": 5202, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:17.200992+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45925, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1859, "end": 1871, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:09.327015+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45926, "user": "wish", "cui": "C0030920", "value": "peptic ulcer", "start": 4758, "end": 4770, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:08.404899+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45927, "user": "wish", "cui": "C0011175", "value": "dehydration", "start": 4532, "end": 4543, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:45.749417+00:00", "manually_created": false, "acc": 0.41796213841315516, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45928, "user": "wish", "cui": "C0011570", "value": "depression", "start": 1886, "end": 1896, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:10.062264+00:00", "manually_created": false, "acc": 0.3455207111086853, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45929, "user": "wish", "cui": "C0011168", "value": "dysphagia", "start": 733, "end": 742, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:29:56.558987+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45930, "user": "wish", "cui": "C0018965", "value": "hematuria", "start": 2468, "end": 2477, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:10.651770+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45931, "user": "wish", "cui": "C0018889", "value": "infection", "start": 6289, "end": 6298, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:30.093363+00:00", "manually_created": false, "acc": 0.31574393251769717, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45932, "user": "wish", "cui": "C0022354", "value": "jaundice", "start": 2519, "end": 2527, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:13.462811+00:00", "manually_created": false, "acc": 0.22590957798956124, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45933, "user": "wish", "cui": "C0022354", "value": "jaundice", "start": 2837, "end": 2845, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:32.274369+00:00", "manually_created": false, "acc": 0.20021699596706105, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45934, "user": "wish", "cui": "C0009241", "value": "deficits", "start": 3937, "end": 3945, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:43.306887+00:00", "manually_created": false, "acc": 0.3275925511564358, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45935, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 3140, "end": 3147, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:41.310996+00:00", "manually_created": false, "acc": 0.6158228132937934, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45936, "user": "wish", "cui": "C0002871", "value": "anemia", "start": 1833, "end": 1839, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:08.041822+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45937, "user": "wish", "cui": "C0033377", "value": "ptosis", "start": 2970, "end": 2976, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:39.510322+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45938, "user": "wish", "cui": "C0002871", "value": "anemia", "start": 4918, "end": 4924, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:14.820269+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45939, "user": "wish", "cui": "C0042769", "value": "viral", "start": 4611, "end": 4616, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:30:55.634769+00:00", "manually_created": false, "acc": 0.42153441798519353, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45940, "user": "wish", "cui": "C1565489", "value": "renal", "start": 5659, "end": 5664, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:31:29.038057+00:00", "manually_created": false, "acc": 0.3914989963780615, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3263, "name": "641", "text": "HISTORY OF PRESENT ILLNESS:, The patient is a 71-year-old Caucasian female with a history of diabetes, osteoarthritis, atrial fibrillation, hypertension, asthma, obstructive sleep apnea on CPAP, diabetic foot ulcer, anemia and left lower extremity cellulitis. She was brought in by the EMS service to Erlanger emergency department with pulseless electrical activity. Her husband states that he was at home with his wife, when she presented to him complaining of fever and chills. She became acutely unresponsive. She was noted to have worsening of her breathing. She took several of her MDIs and then was placed on her CPAP. He went to notify EMS and when he returned, she was found to not be breathing. He stated that she was noted to have no breathing in excess of 10 minutes. He states that the EMS system arrived at the home and she was found not breathing. The patient was intubated at the scene and upon arrival to Erlanger Medical Center, she was found to have pupils fixed and dilated. She was seen by me in the emergency department and was on Neo-Synephrine, dopamine with a blood pressure of 97/22 with a rapid heart rate and again, in an unresponsive state.,REVIEW OF SYSTEMS:, Review of systems was not obtainable.,PAST MEDICAL HISTORY:, Diabetes, osteoarthritis, hypertension, asthma, atrial fibrillation, diabetic foot ulcer and anemia.,PAST SURGICAL HISTORY:, Noncontributory to above.,FAMILY HISTORY:, Mother with history of coronary artery disease.,SOCIAL HISTORY:, The patient is married. She uses no ethanol, no tobacco and no illicits. She has a very support family unit.,MEDICATIONS:, Augmentin; Detrol LA; lisinopril.,IMMUNIZATIONS:, Immunizations were up to date for influenza, negative for Pneumovax.,ALLERGIES:, PENICILLIN.,LABORATORY AT PRESENTATION:, White blood cell count 11, hemoglobin 10.5, hematocrit 32.2, platelets 175,000. Sodium 148, potassium 5.2, BUN 30, creatinine 2.2 and glucose 216. PT was 22.4.,RADIOLOGIC DATA:, Chest x-ray revealed a diffuse pulmonary edema.,PHYSICAL EXAMINATION:,VITAL SIGNS: Blood pressure 97/52, pulse of 79, respirations 16, O2 sat 100%.,HEENT: The patient's pupils were again, fixed and dilated and intubated on the monitor.,CHEST: Poor air movement bilateral with bilateral rales.,CARDIOVASCULAR: Regular rate and rhythm.,ABDOMEN: The abdomen was obese, nondistended and nontender.,EXTREMITIES: Left diabetic foot had oozing pus drainage from the foot.,GU: Foley catheter was in place.,IMPRESSION AND PLAN:,1. Acute cardiac arrest with pulseless electrical activity with hypotensive shock and respiratory failure: Will continue ventilator support. Will rule out pulmonary embolus, rule out myocardial infarction. Continue pressors. The patient is currently on dopamine, Neo-Synephrine and Levophed.,2. Acute respiratory distress syndrome: Will continue ventilatory support.,3. Questionable sepsis: Will obtain blood cultures, intravenous vancomycin and Rocephin given.,4. Hypotensive shock: Will continue pressors. Will check random cortisol. Hydrocortisone was added.,Further inpatient management for this patient will be provided by Dr. R. The patient's status was discussed with her daughter and her husband. The husband states that his wife has been very ill in the past with multiple admissions, but he had never seen her as severely ill as with this event. He states that she completely was not breathing at all and he is aware of the severity of her illness and the gravity of her current prognosis. Will obtain the assistance with cardiology with this admission and will continue pressors and supportive therapy. The family will make an assessment and final decision concerning her long-term management after a 24 hour period.", "last_modified": "2020-03-29 14:43:25.571075+00:00", "annotations": [{"id": 45941, "user": "wish", "cui": "C0035222", "value": "Acute respiratory distress syndrome", "start": 2770, "end": 2805, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:24.988879+00:00", "manually_created": false, "acc": 0.42217936897240227, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45942, "user": "wish", "cui": "C0520679", "value": "obstructive sleep apnea", "start": 162, "end": 185, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:51.755695+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45943, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 1441, "end": 1464, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:04.465676+00:00", "manually_created": false, "acc": 0.6070006978420385, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45944, "user": "wish", "cui": "C0027051", "value": "myocardial infarction", "start": 2658, "end": 2679, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:22.662364+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45945, "user": "wish", "cui": "C0004238", "value": "atrial fibrillation", "start": 119, "end": 138, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:49.615967+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45946, "user": "wish", "cui": "C1456868", "value": "diabetic foot ulcer", "start": 195, "end": 214, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:52.402797+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45947, "user": "wish", "cui": "C0004238", "value": "atrial fibrillation", "start": 1298, "end": 1317, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:02.117907+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45948, "user": "wish", "cui": "C1456868", "value": "diabetic foot ulcer", "start": 1319, "end": 1338, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:02.846030+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45949, "user": "wish", "cui": "C1145670", "value": "respiratory failure", "start": 2561, "end": 2580, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:19.448362+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45950, "user": "wish", "cui": "C0034065", "value": "pulmonary embolus", "start": 2630, "end": 2647, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:20.692060+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45951, "user": "wish", "cui": "C0018790", "value": "cardiac arrest", "start": 2484, "end": 2498, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:14.816376+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45952, "user": "wish", "cui": "C0029408", "value": "osteoarthritis", "start": 103, "end": 117, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:49.047711+00:00", "manually_created": false, "acc": 0.382354204516037, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45953, "user": "wish", "cui": "C0263746", "value": "osteoarthritis", "start": 1260, "end": 1274, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:00.083965+00:00", "manually_created": false, "acc": 0.3797734595055929, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45954, "user": "wish", "cui": "C0206172", "value": "diabetic foot", "start": 2368, "end": 2381, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:11.742733+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45955, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 140, "end": 152, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:50.312479+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45956, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1276, "end": 1288, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:00.632163+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45957, "user": "wish", "cui": "C0021400", "value": "influenza", "start": 1690, "end": 1699, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:06.631495+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45958, "user": "wish", "cui": "C0011860", "value": "diabetes", "start": 93, "end": 101, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:47.980775+00:00", "manually_created": false, "acc": 0.6633429762750487, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45959, "user": "wish", "cui": "C0011849", "value": "Diabetes", "start": 1250, "end": 1258, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:53.783718+00:00", "manually_created": false, "acc": 0.5820456035685702, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45960, "user": "wish", "cui": "C0004096", "value": "asthma", "start": 154, "end": 160, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:51.152069+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45961, "user": "wish", "cui": "C0002871", "value": "anemia", "start": 216, "end": 222, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:31:53.101699+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45962, "user": "wish", "cui": "C0004096", "value": "asthma", "start": 1290, "end": 1296, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:01.234687+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45963, "user": "wish", "cui": "C0002871", "value": "anemia", "start": 1343, "end": 1349, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:03.754440+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45964, "user": "wish", "cui": "C0243026", "value": "sepsis", "start": 2858, "end": 2864, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:29.240906+00:00", "manually_created": false, "acc": 0.2798273073168636, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3264, "name": "516", "text": "HISTORY: , A 59-year-old male presents in followup after being evaluated and treated as an in-patient by Dr. X for acute supraglottitis with airway obstruction and parapharyngeal cellulitis and peritonsillar cellulitis, admitted on 05/23/2008, discharged on 05/24/2008.  Please refer to chart for history and physical and review of systems and medical record.,PROCEDURES PERFORMED:  ,Fiberoptic laryngoscopy identifying about 30% positive Muller maneuver.  No supraglottic edema; +2/4 tonsils with small tonsil cyst, mid tonsil, left.,IMPRESSION:  ,1.  Resolving acute supraglottic edema secondary to pharyngitis and tonsillar cellulitis.,2.  Possible obstructive sleep apnea; however, the patient describes no known history of this phenomenon.,3.  Hypercholesterolemia.,4.  History of anxiety.,5.  History of coronary artery disease.,6.  Hypertension.,RECOMMENDATIONS: , Recommend continuing on Augmentin and tapered prednisone as prescribed by Dr. X.  Cultures are still pending and follow up with Dr. X in the next few weeks for re-evaluation.  I did discuss with the patient whether or not a sleep study would be beneficial and the patient denies any history of obstructive sleep apnea and wishes not to pursue this, but we will leave this open for him to talk with Dr. X on his followup, and he will pay more attention on his sleep pattern.", "last_modified": "2020-03-29 14:43:25.571603+00:00", "annotations": [{"id": 45965, "user": "wish", "cui": "C0520679", "value": "obstructive sleep apnea", "start": 652, "end": 675, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:54.846161+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45966, "user": "wish", "cui": "C0520679", "value": "obstructive sleep apnea", "start": 1166, "end": 1189, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:12.067543+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45967, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 810, "end": 833, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:03.610019+00:00", "manually_created": false, "acc": 0.6981489834095193, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45968, "user": "wish", "cui": "C0020443", "value": "Hypercholesterolemia", "start": 749, "end": 769, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:57.147741+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45969, "user": "wish", "cui": "C0001883", "value": "airway obstruction", "start": 141, "end": 159, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:45.411134+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45970, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 839, "end": 851, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:04.958905+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45971, "user": "wish", "cui": "C0031350", "value": "pharyngitis", "start": 601, "end": 612, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:51.915150+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45972, "user": "wish", "cui": "C0010709", "value": "cyst", "start": 511, "end": 515, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:32:47.498831+00:00", "manually_created": false, "acc": 0.43146527834167814, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45973, "user": "wish", "cui": "C0011884", "value": "Dr", "start": 105, "end": 107, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:32:41.047207+00:00", "manually_created": false, "acc": 0.3069208361522175, "meta_anns": []}, {"id": 45974, "user": "wish", "cui": "C0011884", "value": "Dr", "start": 946, "end": 948, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:33:08.577098+00:00", "manually_created": false, "acc": 0.23634198944657459, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45975, "user": "wish", "cui": "C0011884", "value": "Dr", "start": 1000, "end": 1002, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:33:11.187011+00:00", "manually_created": false, "acc": 0.3515016779739107, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3265, "name": "96", "text": "REASON FOR ADMISSION:,  Intraperitoneal chemotherapy.,HISTORY: , A very pleasant 63-year-old hypertensive, nondiabetic, African-American female with a history of peritoneal mesothelioma.  The patient has received prior intravenous chemotherapy.  Due to some increasing renal insufficiency and difficulties with hydration, it was elected to change her to intraperitoneal therapy.  She had her first course with intraperitoneal cisplatin, which was very difficultly tolerated by her.  Therefore, on the last hospitalization for IP chemo, she was switched to Taxol.  The patient since her last visit has done relatively well.  She had no acute problems and has basically only chronic difficulties.  She has had some decrease in her appetite, although her weight has been stable.  She has had no fever, chills, or sweats.  Activity remains good and she has continued difficulty with depression associated with type 1 bipolar disease.  She had a recent CT scan of the chest and abdomen.  The report showed the following findings.  In the chest, there was a small hiatal hernia and a calcification in the region of the mitral valve.  There was one mildly enlarged mediastinal lymph node.  Several areas of ground-glass opacity were noted in the lower lungs, which were subtle and nonspecific.  No pulmonary masses were noted.  In the abdomen, there were no abnormalities of the liver, pancreas, spleen, and left adrenal gland.  On the right adrenal gland, a 17 x 13 mm right adrenal adenoma was noted.  There were some bilateral renal masses present, which were not optimally evaluated due to noncontrast study.  A hyperdense focus in the lower pole of the left kidney was felt to most probably represent a hemorrhagic renal cyst.  It was unchanged from February and measured 9 mm.  There was again minimal left pelvic/iliac _______ with right and left peritoneal catheters noted and were unremarkable.  Mesenteric nodes were seen, which were similar in appearance to the previous study that was felt somewhat more conspicuous due to opacified bowel adjacent to them.  There was a conglomerate omental mass, which had decreased in volume when compared to previous study, now measuring 8.4 x 1.6 cm.  In the pelvis, there was a small amount of ascites in the right pelvis extending from the inferior right paracolic gutter.  No suspicious osseous lesions were noted.,CURRENT MEDICATIONS: , Norco 10 per 325 one to two p.o. q.4h. p.r.n. pain, atenolol 50 mg p.o. b.i.d., Levoxyl 75 mcg p.o. daily, Phenergan 25 mg p.o. q.4-6h. p.r.n. nausea, lorazepam 0.5 mg every 8 hours as needed for anxiety, Ventolin HFA 2 puffs q.6h. p.r.n., Plavix 75 mg p.o. daily, Norvasc 10 mg p.o. daily, Cymbalta 60 mg p.o. daily, and Restoril 30 mg at bedtime as needed for sleep.,ALLERGIES: , THE PATIENT STATES THAT ON OCCASION LORAZEPAM DOSE PRODUCE HALLUCINATIONS, AND SHE HAD DIFFICULTY TOLERATING ATIVAN.,PHYSICAL EXAMINATION,VITAL SIGNS:  The patient's height is 165 cm, weight is 77 kg.  BSA is 1.8 sq m.  The vital signs reveal blood pressure to be 158/75, heart rate 61 per minute with a regular sinus rhythm, temperature of 96.6 degrees, respiratory rate 18 with an SpO2 of 100% on room air.,GENERAL:  She is normally developed; well nourished; very cooperative; oriented to person, place, and time; and in no distress at this time.  She is anicteric.,HEENT:  EOM is full.  Pupils are equal, round, reactive to light and accommodation.  Disc margins are unremarkable as are the ocular fields.  Mouth and pharynx within normal limits.  The TMs are glistening bilaterally.  External auditory canals are unremarkable.,NECK:  Supple, nontender without adenopathy.  Trachea is midline.  There are no bruits nor is there jugular venous distention.,CHEST:  Clear to percussion and auscultation bilaterally.,HEART:  Regular rate and rhythm without murmur, gallop, or rub.,BREASTS:  Unremarkable.,ABDOMEN:  Slightly protuberant.  Bowel tones are present and normal.  She has no palpable mass, and there is no hepatosplenomegaly.,EXTREMITIES:  Within normal limits.,NEUROLOGICAL:  Nonfocal.,DIAGNOSTIC IMPRESSION,1.  Intraperitoneal mesothelioma, partial remission, as noted by CT scan of the abdomen.,2.  Presumed left lower pole kidney hemorrhagic cyst.,3.  History of hypertension.,4.  Type 1 bipolar disease.,PLAN: , The patient will have appropriate laboratory studies done.  A left renal ultrasound is requested to further delineate the possible hemorrhagic cyst in the lower left pole of the left kidney.  Interventional radiology will access for ports in the abdomen.  She will receive chemotherapy intraperitoneally.  The plan will be to use intraperitoneal Taxol.", "last_modified": "2020-03-29 14:43:25.572115+00:00", "annotations": [{"id": 45976, "user": "wish", "cui": "C1565489", "value": "renal insufficiency", "start": 269, "end": 288, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:37.354676+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45977, "user": "wish", "cui": "C0018524", "value": "HALLUCINATIONS", "start": 2824, "end": 2838, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:34:02.552009+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45978, "user": "wish", "cui": "C3489393", "value": "hiatal hernia", "start": 1058, "end": 1071, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:53.586051+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45979, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 4243, "end": 4255, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:25.767848+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45980, "user": "wish", "cui": "C0027765", "value": "NEUROLOGICAL", "start": 4038, "end": 4050, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:34:10.466425+00:00", "manually_created": false, "acc": 0.3186451615835371, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45981, "user": "wish", "cui": "C0011570", "value": "depression", "start": 879, "end": 889, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:39.197716+00:00", "manually_created": false, "acc": 0.5936750710427917, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45982, "user": "wish", "cui": "C0005586", "value": "bipolar", "start": 913, "end": 920, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:52.379262+00:00", "manually_created": false, "acc": 0.440304555148024, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45983, "user": "wish", "cui": "C0037284", "value": "lesions", "start": 2340, "end": 2347, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:34:00.337395+00:00", "manually_created": false, "acc": 0.4711664559242475, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45984, "user": "wish", "cui": "C0005586", "value": "bipolar", "start": 4268, "end": 4275, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:27.493983+00:00", "manually_created": false, "acc": 0.35997115535464863, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45985, "user": "wish", "cui": "C0011854", "value": "type 1", "start": 906, "end": 912, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:42.521217+00:00", "manually_created": false, "acc": 0.5226589019195093, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45986, "user": "wish", "cui": "C0011854", "value": "Type 1", "start": 4261, "end": 4267, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:26.525615+00:00", "manually_created": false, "acc": 0.3689247130958623, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45987, "user": "wish", "cui": "C0010709", "value": "cyst", "start": 1719, "end": 1723, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:33:57.526267+00:00", "manually_created": false, "acc": 0.3789974686347847, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45988, "user": "wish", "cui": "C0010709", "value": "cyst", "start": 4222, "end": 4226, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:34:11.994893+00:00", "manually_created": false, "acc": 0.43844643908592906, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45989, "user": "wish", "cui": "C0010709", "value": "cyst", "start": 4436, "end": 4440, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:28.465110+00:00", "manually_created": false, "acc": 0.49341893039278806, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3266, "name": "2124", "text": "INDICATIONS FOR PROCEDURE:, A 51-year-old, obese, white female with positive family history of coronary disease and history of chest radiation for Hodgkin disease 20 years ago with no other identifiable risk factors who presents with an acute myocardial infarction with elevated enzymes. The chest pain occurred early Tuesday morning. She was treated with Plavix, Lovenox, etc., and transferred for coronary angiography and possible PCI. The plan was discussed with the patient and all questions answered.,PROCEDURE NOTE:, Following sterile prep and drape, the right groin and instillation of 1% Xylocaine anesthesia, the right femoral artery was percutaneously entered with a single wall puncture. A 6-French sheath inserted. Selective left and right coronary injections performed using Judkins coronary catheters with a 6-French pigtail catheter used to obtain left ventricle pressures, and a left ventriculography. The left pullback pressure. The catheters withdrawn. Sheath injection. Hemostasis obtained with a 6-French Angio-Seal device. She tolerated the procedure well.,Left ventricular end-diastolic pressure equals 25 mmHg post A wave. No aortic valve or systolic gradient on pullback.,ANGIOGRAPHIC FINDINGS:,I. Left coronary artery: The left main coronary artery is,normal. The left anterior descending extends to the apex and has only minor luminal irregularities within the midportion of the vessel. Normal diagonal branches. Normal septal perforator branches. The left circumflex is a nondominant vessel with only minor irregularities with normal obtuse marginal branches.,II. Right coronary artery: The proximal right coronary artery has a focal calcification. There is minor plaque with luminal irregularity in the proximal and midportion of the vessel with no narrowing greater than 10 to 20% at most. The right coronary artery is a dominant system which gives off normal posterior,descending and posterior lateral branches. TIMI 3 flow is present.,III. Left ventriculogram: The left ventricle is slightly enlarged with normal contraction of the base, but, with wall motion abnormality involving the anteroapical and inferoapical left ventricle with hypokinesis within the apical portion. Ejection fraction estimated 40%, 1+ mitral regurgitation (echocardiogram ordered).,DISCUSSION:, Recent inferoapical mild myocardial infarction by left ventriculography and cardiac enzymes with elevated left ventricular end-diastolic pressure post A wave, but, only minor residual coronary artery plaque with calcification proximal right coronary artery.,PLAN:, Medical treatment is contemplated, including ACE inhibitor, a beta blocker, aspirin, Plavix, nitrates. An echocardiogram is ordered to exclude apical left ventricular thrombus and to further assess ejection fraction.", "last_modified": "2020-03-29 14:43:25.572645+00:00", "annotations": [{"id": 45990, "user": "wish", "cui": "C0155626", "value": "acute myocardial infarction", "start": 237, "end": 264, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:39.831375+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45991, "user": "wish", "cui": "C0027051", "value": "myocardial infarction", "start": 2327, "end": 2348, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:48.429926+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45992, "user": "wish", "cui": "C0010054", "value": "coronary disease", "start": 95, "end": 111, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:37.118751+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 45993, "user": "wish", "cui": "C1299433", "value": "left main", "start": 1248, "end": 1257, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:35:47.265141+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45994, "user": "wish", "cui": "C0028754", "value": "obese", "start": 43, "end": 48, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:36.377335+00:00", "manually_created": false, "acc": 0.3616767134370854, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3267, "name": "1377", "text": "CHIEF COMPLAINT: , Penile discharge, infected-looking glans.,HISTORY OF PRESENT ILLNESS: , The patient is a 67-year-old African-American male, who was recently discharged from the hospital on July 21, 2008 after being admitted for altered mental status and before that after undergoing right above knee amputation for wet gangrene.  The patient was transferred to Nursing Home and presents today from the nursing home with complaints of bleeding from the right AKA stump and penile discharge.  As per the patient during his hospitalizations over here, he had indwelling Foley catheter for a few days and when he was discharged at the nursing home he was discharged without the catheter.  However, the patient was brought back to the ED today when he suffered fall yesterday and started bleeding from his stump.  While placing the catheter in the ED on retraction of foreskin purulent discharge was seen from the penis and the glans appeared infected, so urology consult was placed.,REVIEW OF SYSTEMS: , Negative except as in the HPI.,PAST MEDICAL HISTORY: , Significant for end-stage renal disease on dialysis, hypertension, peripheral vascular disease, coronary artery disease, congestive heart failure, diabetes, and hyperlipidemia.,PAST SURGICAL HISTORY:  ,Right AKA,MEDICATIONS:,  Novolin, Afrin, Nephro-Vite, Neurontin, lisinopril, furosemide, Tums, labetolol, Plavix, nitroglycerin, Aricept, omeprazole, oxycodone, Norvasc, Renagel, and morphine.,ALLERGIES: , PENICILLIN and ADHESIVE TAPE.,FAMILY HISTORY: , Significant for hypertension, hyperlipidemia, diabetes, chronic renal insufficiency, and myocardial infarction.,SOCIAL HISTORY: , The patient lives alone.  He is unemployed, disabled.  He has history of tobacco use in the past.  He denies alcohol or drug abuse.,PHYSICAL EXAMINATION:,GENERAL:  A well-appearing African-American male lying comfortably in bed, in acute distress.,NECK:  Supple.,LUNGS:  Clear to auscultation bilaterally.,CARDIOVASCULAR:  S1 and S2, normal.,ABDOMEN:  Soft, nondistended, and nontender.,GENITOURINARY:  Penis is not circumcised.  Currently, indwelling Foley catheter in place.  On retraction of the foreskin, pale-looking glans tip with areas of yellow-white tissue.  The proximal glans appeared pink.  The patient currently has indwelling Foley catheter and glans slightly tender to touch.  However, no purulent discharge was seen on compression of the glans.  Otherwise on palpation, no other deformity noticed.  Bilateral testes descended.  No palpable abnormality.  No evidence of infection in his perineal area.,EXTREMITIES:  Right AKA.,NEUROLOGIC:  Awake, alert, and oriented.  No sensory or motor deficit.,LABORATORY DATA: , I independently reviewed the lab work done on the patient.  The patient had a UA done in the ED which showed few bacteria, white blood cells 6 to 12, and a few epithelial cells which were negative.  His basic metabolic panel with creatinine of 7.2 and potassium of 5, otherwise normal.  CBC with a white blood cell count of 11.5, hemoglobin of 9.5, and INR of 1.13.,IMPRESSION: , A 67-year-old male with multiple comorbidities with penile discharge and pale-appearing glans.  It seems that the patient has had multiple catheterizations recently and has history of peripheral vascular disease.  I think it is due to chronic ischemic changes.,RECOMMENDATIONS: , Our recommendation would be:,1.  To remove the Foley catheter.,2.  Local hygiene.,3.  Local application of bacitracin ointment.,4.  Antibiotic for urinary tract infection.,5.  Follow up as needed.  Of note, it was explained to the patient that the appearance of this glans may improve or may get worsened but at this point, there is no indication to operate on him.  If increased purulent discharge, the patient was asked to call us sooner, otherwise follow up as scheduled.", "last_modified": "2020-03-29 14:43:25.573182+00:00", "annotations": [{"id": 45995, "user": "wish", "cui": "C0085096", "value": "peripheral vascular disease", "start": 1125, "end": 1152, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:03.108268+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45996, "user": "wish", "cui": "C0403447", "value": "chronic renal insufficiency", "start": 1570, "end": 1597, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:10.087077+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45997, "user": "wish", "cui": "C0085096", "value": "peripheral vascular disease", "start": 3240, "end": 3267, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:19.837594+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45998, "user": "wish", "cui": "C0018802", "value": "congestive heart failure", "start": 1179, "end": 1203, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:04.534734+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 45999, "user": "wish", "cui": "C0022661", "value": "end-stage renal disease", "start": 1074, "end": 1097, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:00.206529+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46000, "user": "wish", "cui": "C0042029", "value": "urinary tract infection", "start": 3483, "end": 3506, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:27.416096+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46001, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 1154, "end": 1177, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:04.223582+00:00", "manually_created": false, "acc": 0.5659365203923152, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46002, "user": "wish", "cui": "C0027051", "value": "myocardial infarction", "start": 1603, "end": 1624, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:10.799588+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46003, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 1219, "end": 1233, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:05.967808+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46004, "user": "wish", "cui": "C0020473", "value": "hyperlipidemia", "start": 1544, "end": 1558, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:08.664365+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46005, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1111, "end": 1123, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:02.260372+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46006, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 1530, "end": 1542, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:06.803119+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46007, "user": "wish", "cui": "C0013146", "value": "drug abuse", "start": 1764, "end": 1774, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:11.783820+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46008, "user": "wish", "cui": "C0854135", "value": "infection", "start": 2529, "end": 2538, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:14.292897+00:00", "manually_created": false, "acc": 0.5380169188171087, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46009, "user": "wish", "cui": "C2363741", "value": "infected", "start": 37, "end": 45, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:35:56.544230+00:00", "manually_created": false, "acc": 0.37332235850640794, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46010, "user": "wish", "cui": "C0011849", "value": "diabetes", "start": 1205, "end": 1213, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:05.234605+00:00", "manually_created": false, "acc": 0.6186123081557326, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46011, "user": "wish", "cui": "C0011849", "value": "diabetes", "start": 1560, "end": 1568, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:09.394150+00:00", "manually_created": false, "acc": 0.6562451322288061, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3268, "name": "605", "text": "SUBJECTIVE:,  The patient comes back to see me today.  She is a pleasant 77-year-old Caucasian female who had seen Dr. XYZ with right leg pain.  She has a history of prior laminectomy for spinal stenosis.  She has seen Dr. XYZ with low back pain and lumbar scoliosis post laminectomy syndrome, lumbar spinal stenosis, and clinical right L2 radiculopathy, which is symptomatic.  Dr. XYZ had performed two right L2-L3 transforaminal epidural injections, last one in March 2005.  She was subsequently seen and Dr. XYZ found most of her remaining symptoms are probably coming from her right hip.  An x-ray of the hip showed marked degenerative changes with significant progression of disease compared to 08/04/2004 study.  Dr. XYZ had performed right intraarticular hip injection on 04/07/2005.  She was last seen on 04/15/2005.  At that time, she had the hip injection that helped her briefly with her pain.  She is not sure whether or not she wants to proceed with hip replacement.  We recommend she start using a cane and had continued her on some pain medicines.,The patient comes back to see me today.  She continues to complain of significant pain in her right hip, especially with weightbearing or with movement.  She said she had made an appointment to see an orthopedic surgeon in Newton as it is closer and more convenient for her.  She is taking Ultracet or other the generic it sounds like, up to four times daily.  She states she can take this much more frequently as she still has significant pain symptoms.  She is using a cane to help her ambulate.,PAST MEDICAL HISTORY:,  Essentially unchanged from her visit of 04/15/2005.,PHYSICAL EXAMINATION:,General:  Reveals a pleasant Caucasian female.,Vital Signs:  Height is 5 feet 4 inches.  Weight is 149 pounds.  She is afebrile.,HEENT:  Benign.,Neck:  Shows functional range of movements with a negative Spurling's.,Musculoskeletal:  Examination shows some mild degenerative joint disease of both knees with grade weakness of her right hip flexors and half-grade weakness of her right hip adductors and right quadriceps, as compared to the left.  Straight leg raises are negative bilaterally.  Posterior tibials are palpable bilaterally.,Skin and Lymphatics:  Examination of the skin does not reveal any additional scars, rashes, cafe au lait spots or ulcers.  No significant lymphadenopathy noted.,Spine:  Examination shows lumbar scoliosis with surgical scar with no major tenderness.  Spinal movements are limited but functional.,Neurological:  She is alert and oriented with appropriate mood and affect.  She has normal tone and coordination.  Reflexes are 2+ and symmetrical.  Sensations are intact to pinprick.,FUNCTIONAL EXAMINATION:,  Gait has a normal stance and swing phase with no antalgic component to it.,IMPRESSION:,1.  Degenerative disk disease of the right hip, symptomatic.,2.  Low back syndrome, lumbar spinal stenosis, clinically right L2 radiculopathy, stable.,3.  Low back pain with lumbar scoliosis post laminectomy syndrome, stable.,4.  Facet and sacroiliac joint syndrome on the right, stable.,5.  Post left hip arthroplasty.,6.  Chronic pain syndrome.,RECOMMENDATIONS:,  The patient is symptomatic primarily on her right hip and is planning on seeing an orthopedic surgeon for possible right hip replacement.  In the interim, her Ultracet is not quite taking care of her pain.  I have asked her to discontinue it and we will start her on Tylenol #3, up to four times a day.  I have written a prescription for this for 120 tablets and two refills.  The patient will call for the refills when she needs them.  I will plan further follow up in six months, sooner if needed.  She voiced understanding and is in agreement with this plan.  Physical exam findings, history of present illness and recommendations were performed with and in agreement with Dr. Goel's findings.", "last_modified": "2020-03-29 14:43:25.573687+00:00", "annotations": [{"id": 46012, "user": "wish", "cui": "C0029408", "value": "degenerative joint disease", "start": 1921, "end": 1947, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:38.872937+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46013, "user": "wish", "cui": "C0158288", "value": "lumbar spinal stenosis", "start": 294, "end": 316, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:35.603467+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46014, "user": "wish", "cui": "C0158288", "value": "lumbar spinal stenosis", "start": 2873, "end": 2895, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:52.727770+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46015, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 2335, "end": 2350, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:42.790831+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46016, "user": "wish", "cui": "C0700594", "value": "radiculopathy", "start": 340, "end": 353, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:36.666512+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46017, "user": "wish", "cui": "C0700594", "value": "radiculopathy", "start": 2917, "end": 2930, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:05.536636+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46018, "user": "wish", "cui": "C0041582", "value": "ulcers", "start": 2311, "end": 2317, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:36:41.156000+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3269, "name": "485", "text": "SUBJECTIVE:,  The patient comes back to see me today.  She is a pleasant 73-year-old Caucasian female who had seen Dr. XYZ with low back pain, lumbar degenerative disc disease, lumbar spondylosis, facet and sacroiliac joint syndrome, lumbar spinal stenosis primarily bilateral recess, intermittent lower extremity radiculopathy, DJD of both knees, bilateral pes anserinus bursitis, and chronic pain syndrome.  Dr. XYZ had performed right and left facet and sacroiliac joint injections, subsequent right L3 to S1 medial branch blocks and radiofrequency ablation on the right from L3 to S1.  She was subsequently seen with some mid back pain and she had right T8-T9 and T9-T10 facet injections on 10/28/2004.  She was last seen on 04/08/2005 with recurrent pain in her low back on the right.  Dr. XYZ repeated her radiofrequency ablation on the right side from L3-S1 on 05/04/2005.,The patient comes back to see me today.  She states that the radiofrequency ablation has helped her significantly there, but she still has one spot in her low back that seems to be hurting her on the right, and seems to be pointing to her right sacroiliac joint.  She is also complaining of pain in both knees.  She says that 20 years ago she had a cortisone shot in her knees, which helped her significantly.  She has not had any x-rays for quite some time.  She is taking some Lortab 7.5 mg tablets, up to four daily, which help her with her pain symptoms.  She is also taking Celebrex through Dr. S\u2019 office.,PAST MEDICAL HISTORY:,  Essentially unchanged from my visit of 04/08/2005.,PHYSICAL EXAMINATION:,General:  Reveals a pleasant Caucasian female.,Vital Signs:  Height is 5 feet 5 inches.  Weight is 183 pounds.  She is afebrile.,HEENT:  Benign.,Neck:  Shows functional range of movements with a negative Spurling's.,Musculoskeletal:  Examination shows degenerative joint disease of both knees, with medial and lateral joint line tenderness, with tenderness at both pes anserine bursa.  Straight leg raises are negative bilaterally.  Posterior tibials are palpable bilaterally.,Skin and Lymphatics:  Examination of the skin does not reveal any additional scars, rashes, cafe au lait spots or ulcers.  No significant lymphadenopathy noted.,Spine:  Examination shows decreased lumbar lordosis with tenderness that seems to be in her right sacroiliac joint.  She has no other major tenderness.  Spinal movements are limited but functional.,Neurological:  She is alert and oriented with appropriate mood and affect.  She has normal tone and coordination.  Reflexes are 2+ and symmetrical.  Sensation is intact to pinprick.,FUNCTIONAL EXAMINATION:,  Gait has a normal stance and swing phase with no antalgic component to it.,IMPRESSION:,1.  Low back syndrome with lumbar degenerative disc disease, lumbar spinal stenosis, and facet joint syndrome on the right L4-5 and L5-S1.,2.  Improved, spinal right L3-S1 radiofrequency ablation.,3.  Right sacroiliac joint sprain/strain, symptomatic.,4.  Left lumbar facet joint syndrome, stable.,6.  Right thoracic facet joint syndrome, stable.,7.  Lumbar spinal stenosis, primarily lateral recess with intermittent lower extremity radiculopathy, stable.,8.  Degenerative disc disease of both knees, symptomatic.,9.  Pes anserinus bursitis, bilaterally symptomatic.,10.  Chronic pain syndrome.,RECOMMENDATIONS:,  Dr. XYZ and I discussed with the patient her pathology.  She has some symptoms in her low back on the right side at the sacroiliac joint.  Dr. XYZ will plan having her come in and injecting her right sacroiliac joint under fluoroscopy.  She is also having pain in both knees.  We will plan on x-rays of both knees, AP and lateral, and plan on seeing her back on Monday or Friday for possible intraarticular and/or pes anserine bursa injections bilaterally.  I explained the rationale for each of these injections, possible complications and she wishes to proceed.  In the interim, she can continue on Lortab and Celebrex.  We will plan for the follow up following these interventions, sooner if needed.  She voiced understanding and agreement.  Physical exam findings, history of present illness, and recommendations were performed with and in agreement with Dr. Goel's findings.", "last_modified": "2020-03-29 14:43:25.574205+00:00", "annotations": [{"id": 46019, "user": "wish", "cui": "C0029408", "value": "degenerative joint disease", "start": 1840, "end": 1866, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:22.209249+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46020, "user": "wish", "cui": "C0158266", "value": "degenerative disc disease", "start": 150, "end": 175, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:16.633085+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46021, "user": "wish", "cui": "C0158266", "value": "degenerative disc disease", "start": 2753, "end": 2778, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:33.526068+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46022, "user": "wish", "cui": "C0158266", "value": "Degenerative disc disease", "start": 3180, "end": 3205, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:41.578076+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46023, "user": "wish", "cui": "C0158288", "value": "lumbar spinal stenosis", "start": 234, "end": 256, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:18.105249+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46024, "user": "wish", "cui": "C0158288", "value": "lumbar spinal stenosis", "start": 2780, "end": 2802, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:36.595481+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46025, "user": "wish", "cui": "C0158288", "value": "Lumbar spinal stenosis", "start": 3070, "end": 3092, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:37.341039+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46026, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 2203, "end": 2218, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:29.294663+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46027, "user": "wish", "cui": "C0700594", "value": "radiculopathy", "start": 314, "end": 327, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:19.926637+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46028, "user": "wish", "cui": "C0700594", "value": "radiculopathy", "start": 3153, "end": 3166, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:39.545144+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46029, "user": "wish", "cui": "C0006444", "value": "bursitis", "start": 372, "end": 380, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:21.147103+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46030, "user": "wish", "cui": "C0024003", "value": "lordosis", "start": 2269, "end": 2277, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:31.985917+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46031, "user": "wish", "cui": "C0006444", "value": "bursitis", "start": 3252, "end": 3260, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:42.320487+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46032, "user": "wish", "cui": "C0041582", "value": "ulcers", "start": 2179, "end": 2185, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:24.482353+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}]}, {"id": 3270, "name": "1694", "text": "REASON FOR CONSULT:, Renal insufficiency.,HISTORY OF PRESENT ILLNESS:, A 48-year-old African-American male with a history of coronary artery disease, COPD, congestive heart failure with EF of 20%-25%, hypertension, renal insufficiency, and recurrent episodes of hypertensive emergency, admitted secondary to shortness of breath and productive cough. The patient denies any chest pain, palpitations, syncope, or fever. Denied any urinary disturbances, difficulty, burning micturition, hematuria, or back pain. Nephrology is consulted regarding renal insufficiency.,REVIEW OF SYSTEMS:, Reviewed entirely and negative except for HPI.,PAST MEDICAL HISTORY:, Hypertension, congestive heart failure with ejection fraction of 20%-25% in December 2005, COPD, mild diffuse coronary artery disease, and renal insufficiency.,ALLERGIES:, NO KNOWN DRUG ALLERGIES.,MEDICATIONS:, Clonidine 0.3 p.o. q.8, aspirin 325 daily, hydralazine 100 q.8, Lipitor 20 at bedtime, Toprol XL 100 daily.,FAMILY HISTORY:, Noncontributory.,SOCIAL HISTORY:, The patient denies any alcohol, IV drug abuse, tobacco, or any recreational drugs.,PHYSICAL EXAMINATION:,VITAL SIGNS: Blood pressure 180/110. Temperature 98.1. Pulse rate 60. Respiratory rate 23. O2 sat 95% on room air.,GENERAL: A 48-year-old African-American male in no acute distress.,HEENT: Pupils equal, round, and reactive to light and accommodation. No pallor or icterus.,NECK: No JVD, bruit, or lymphadenopathy.,HEART: S1 and S2, regular rate and rhythm, no murmurs, rubs, or gallops.,LUNGS: Clear. No wheezes or crackles.,ABDOMEN: Soft, nontender, nondistended, no organomegaly, bowel sounds present.,EXTREMITIES: No cyanosis, clubbing, or edema.,CNS: Exam is nonfocal.,LABS:, WBC 7, H and H 13 and 40, platelets 330, PT 12, PTT 26, CO2 20, BUN 27, creatinine 3.1, cholesterol 174, BNP 973, troponin 0.18. Previous creatinine levels were 2.7 in December. Urine drug screen positive for cocaine.,ASSESSMENT:, A 48-year-old African-American male with a history of coronary artery disease, congestive heart failure, COPD, hypertension, and renal insufficiency with:,1. Hypertensive emergency.,2. Acute on chronic renal failure.,3. Urine drug screen positive.,4. Question CHF versus COPD exacerbation.,PLAN:,1. Most likely, renal insufficiency is a chronic problem. Hypertensive etiology worsened by the patient's chronic cocaine abuse.,2. Control blood pressure with medications as indicated. Hypertensive emergency most likely related to cocaine drug abuse.,Thank you for this consult. We will continue to follow the patient with you.", "last_modified": "2020-03-29 14:43:25.574714+00:00", "annotations": [{"id": 46033, "user": "wish", "cui": "C0018802", "value": "congestive heart failure", "start": 156, "end": 180, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:57.185671+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46034, "user": "wish", "cui": "C0018802", "value": "congestive heart failure", "start": 668, "end": 692, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:25.042707+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46035, "user": "wish", "cui": "C0018802", "value": "congestive heart failure", "start": 2019, "end": 2043, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:44.462008+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46036, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 125, "end": 148, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:54.928899+00:00", "manually_created": false, "acc": 0.7795233686501091, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46037, "user": "wish", "cui": "C0010068", "value": "coronary artery disease", "start": 764, "end": 787, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:27.917596+00:00", "manually_created": false, "acc": 0.6805140320253266, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46038, "user": "wish", "cui": "C0010054", "value": "coronary artery disease", "start": 1994, "end": 2017, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:41.983334+00:00", "manually_created": false, "acc": 0.7182792008121792, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46039, "user": "wish", "cui": "C0022661", "value": "chronic renal failure", "start": 2134, "end": 2155, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:47.913010+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46040, "user": "wish", "cui": "C1565489", "value": "Renal insufficiency", "start": 21, "end": 40, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:52.204303+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46041, "user": "wish", "cui": "C1565489", "value": "renal insufficiency", "start": 215, "end": 234, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:58.646263+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46042, "user": "wish", "cui": "C1565489", "value": "renal insufficiency", "start": 543, "end": 562, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:20.026127+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46043, "user": "wish", "cui": "C1565489", "value": "renal insufficiency", "start": 793, "end": 812, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:28.861754+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46044, "user": "wish", "cui": "C1565489", "value": "renal insufficiency", "start": 2069, "end": 2088, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:46.507586+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46045, "user": "wish", "cui": "C1565489", "value": "renal insufficiency", "start": 2252, "end": 2271, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:50.174493+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46046, "user": "wish", "cui": "C0497156", "value": "lymphadenopathy", "start": 1426, "end": 1441, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:37.977462+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46047, "user": "wish", "cui": "C0020538", "value": "blood pressure", "start": 2376, "end": 2390, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:55.715889+00:00", "manually_created": false, "acc": 0.4055355102062653, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46048, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 201, "end": 213, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:57.927508+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46049, "user": "wish", "cui": "C0020538", "value": "Hypertension", "start": 654, "end": 666, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:23.542326+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46050, "user": "wish", "cui": "C0020538", "value": "hypertension", "start": 2051, "end": 2063, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:45.748043+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46051, "user": "wish", "cui": "C0020538", "value": "hypertensive", "start": 262, "end": 274, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:03.522806+00:00", "manually_created": false, "acc": 0.5438426399913531, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46052, "user": "wish", "cui": "C0013146", "value": "recreational", "start": 1087, "end": 1099, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:34.411841+00:00", "manually_created": false, "acc": 0.5180606157908692, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46053, "user": "wish", "cui": "C0020538", "value": "Hypertensive", "start": 2098, "end": 2110, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:47.218704+00:00", "manually_created": false, "acc": 0.35889706854201014, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46054, "user": "wish", "cui": "C0020538", "value": "Hypertensive", "start": 2294, "end": 2306, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:54.180009+00:00", "manually_created": false, "acc": 0.5038270683658527, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46055, "user": "wish", "cui": "C0020538", "value": "Hypertensive", "start": 2422, "end": 2434, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:56.598214+00:00", "manually_created": false, "acc": 0.3262989480814324, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46056, "user": "wish", "cui": "C0013146", "value": "drug abuse", "start": 1059, "end": 1069, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:32.038523+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46057, "user": "wish", "cui": "C0013146", "value": "drug abuse", "start": 2476, "end": 2486, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:57.311008+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46058, "user": "wish", "cui": "C0018965", "value": "hematuria", "start": 484, "end": 493, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:13.734147+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46059, "user": "wish", "cui": "C0338614", "value": "episodes", "start": 250, "end": 258, "validated": true, "correct": false, "deleted": false, "alternative": false, "killed": true, "last_modified": "2020-04-01 22:38:02.370285+00:00", "manually_created": false, "acc": 0.5178495616474715, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46060, "user": "wish", "cui": "C0085762", "value": "alcohol", "start": 1047, "end": 1054, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:29.582584+00:00", "manually_created": false, "acc": 0.48287518134315355, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46061, "user": "wish", "cui": "C0024117", "value": "COPD", "start": 150, "end": 154, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:37:56.468797+00:00", "manually_created": false, "acc": 0.4945630420771805, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46062, "user": "wish", "cui": "C0024117", "value": "COPD", "start": 745, "end": 749, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:26.312057+00:00", "manually_created": false, "acc": 0.3808427481106057, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46063, "user": "wish", "cui": "C0024117", "value": "COPD", "start": 2045, "end": 2049, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:45.200384+00:00", "manually_created": false, "acc": 0.4834381047688081, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46064, "user": "wish", "cui": "C0024117", "value": "COPD", "start": 2211, "end": 2215, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:49.467670+00:00", "manually_created": false, "acc": 0.47003333442157275, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46065, "user": "wish", "cui": "C0018802", "value": "CHF", "start": 2200, "end": 2203, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:38:48.742279+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}, {"id": 3271, "name": "1577", "text": "HISTORY OF PRESENT ILLNESS:,  This is a 77-year-old male, who presents with gross hematuria that started this morning.  The patient is a difficult historian, does have a speech impediment, slow to answer questions, but daughter was able to answer lot of questions too.  He is complaining of no other pain.  He denies any abdominal pain.  Denies any bleeding anywhere else.  Denies any bruising.  He had an episode similar to this a year ago where it began the same with hematuria.  He was discharged after a workup in the hospital, in the emergency room, with Levaquin.  Three days later, he returned with a very large hematoma to his left neck and a coagulopathy with significant bleeding.  His H and H was down in the 6 level.  He received blood transfusions.  He was diagnosed with a malignancy, coagulopathy, and sounds like was in critical condition.  Family actually states that they were told that he was unlikely to live through that event, but he did.  Since then, he has had no bleeding.  The patient has had no fever.  No cough.  No chest pain or shortness of breath.  No bleeding gums.  No blurred vision.  No headache.  No recent falls or trauma.  He has had no nausea or vomiting.  No diarrhea.  No blood in the stool or melena.  No leg or calf pain.  No joint pain.  No rashes.  No swollen glands.  He has no numbness, weakness or tingling to his extremities.  No acute anxiety or depression.,PAST MEDICAL HISTORY: , Has prostate cancer.,MEDICATION: , He is receiving Lupron injection by Dr. Y. The only other medication that he takes is Tramadol.,SOCIAL HISTORY: , He does not smoke or drink.,PHYSICAL EXAMINATION:,Vital Signs:  Are all reviewed on triage.,General:  He is alert.  Answers slowly with a speech impediment, but answers appropriately.,HEENT:  Pupils equal, round, and reactive to light.  Normal extraocular muscles.  Nonicteric sclerae.  Conjunctivae are not pale.  His oropharynx is clear.  His mucous membranes are moist.,Heart:  Regular rate and rhythm, with no murmurs.,Lungs:  Clear.,Abdomen:  Soft, nontender, nondistended.  Normal bowel sounds.  No organomegaly or mass.,Extremities:  No calf tenderness, erythema or warmth.  He has no bruises noted.,Neurological:  Cranial nerves II through XII are intact.  He has 5/5 strength throughout.  ,GU:  Normal.,LABORATORY DATA:  ,The patient did on urinalysis have few red blood cells.  His urine was also grossly red, although no blood clots or gross blood was noted.  It was more of a red fluid.  He had a mild decrease in H and H at 12.1 and 34.6.  His white count was normal at 7.2.  His PT was elevated at 15.9.  PTT elevated at 36.4.  INR is 1.4.  His comprehensive metabolic profile is normal except for BUN of 19.,CONDITION: , The patient is stable at this time, although because of the history of the same happening and the patient beginning in the same fashion his history of coagulopathy, the patient is discussed with Dr. X and he is admitted for orders.  Also we will consult Dr. Y, see orders for further.", "last_modified": "2020-03-29 14:43:25.575246+00:00", "annotations": [{"id": 46066, "user": "wish", "cui": "C0005779", "value": "coagulopathy", "start": 651, "end": 663, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:13.712010+00:00", "manually_created": false, "acc": 0.3838111188129867, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46067, "user": "wish", "cui": "C0005779", "value": "coagulopathy", "start": 799, "end": 811, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:15.543257+00:00", "manually_created": false, "acc": 0.2145861484016487, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46068, "user": "wish", "cui": "C0005779", "value": "coagulopathy", "start": 2868, "end": 2880, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:21.843973+00:00", "manually_created": false, "acc": 0.33288367305576044, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46069, "user": "wish", "cui": "C0011570", "value": "depression", "start": 1396, "end": 1406, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:17.197406+00:00", "manually_created": false, "acc": 0.4542327638367848, "meta_anns": [{"name": "Status", "value": "Other", "acc": 1.0, "validated": true}]}, {"id": 46070, "user": "wish", "cui": "C0018965", "value": "hematuria", "start": 82, "end": 91, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:10.208275+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46071, "user": "wish", "cui": "C0018965", "value": "hematuria", "start": 470, "end": 479, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:12.133207+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}, {"id": 46072, "user": "wish", "cui": "C0041834", "value": "erythema", "start": 2142, "end": 2150, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "last_modified": "2020-04-01 22:39:19.627012+00:00", "manually_created": false, "acc": 1.0, "meta_anns": [{"name": "Status", "value": "Confirmed", "acc": 1.0, "validated": true}]}]}]}]}
\ No newline at end of file
diff --git a/medcat-scripts/evaluate_mct_export/mct_analysis.py b/medcat-scripts/evaluate_mct_export/mct_analysis.py
new file mode 100644
index 00000000..28ec252f
--- /dev/null
+++ b/medcat-scripts/evaluate_mct_export/mct_analysis.py
@@ -0,0 +1,675 @@
+import plotly
+import plotly.graph_objects as go
+from medcat.cat import CAT
+from datetime import date
+from typing import cast
+
+import os
+import json
+import torch
+import math
+from torch import nn
+import numpy as np
+import pandas as pd
+from collections import Counter
+from typing import Iterator, Optional, Union, TypedDict, Any
+from medcat.components.addons.meta_cat.mctokenizers.tokenizers import (
+    TokenizerWrapperBase)
+
+from medcat.components.addons.meta_cat.ml_utils import create_batch_piped_data
+
+from medcat.components.addons.meta_cat.meta_cat import MetaCATAddon, MetaCAT
+from medcat.stats.stats import get_stats
+from medcat.utils.legacy.identifier import is_legacy_model_pack
+from medcat.utils.legacy.convert_meta_cat import get_meta_cat_from_old
+from medcat.config.config_meta_cat import ConfigMetaCAT
+from medcat.components.addons.meta_cat.data_utils import (
+    prepare_from_json, encode_category_values)
+from medcat.storage.serialisers import deserialise
+from medcat.data.mctexport import (
+    MedCATTrainerExport as _MedCATTrainerExport,
+    MedCATTrainerExportAnnotation, iter_anns)
+import warnings
+
+
+DATETIME_FORMAT = r"%Y-%m-%d:%H:%M:%S"
+
+
+class AnnotationOutput(TypedDict, total=False):
+    project_name: str
+    document_name: str
+
+
+class MetaAnnotationPredictions(TypedDict):
+    predictions: dict
+    meta_values: Any
+
+
+class MedcatTrainer_export(object):
+    """
+    Class to analyse MedCATtrainer exports
+    """
+
+    def __init__(self, mct_export_paths: list[str],
+                 model_pack_path: Optional[str] = None):
+        """
+        :param mct_export_paths: List of paths to MedCATtrainer exports
+        :param model_pack_path: Path to medcat modelpack
+        """
+        self.cat: Optional[CAT] = None
+        self.is_legacy_model_pack = False
+        if model_pack_path:
+            self.cat = CAT.load_model_pack(model_pack_path)
+            mpp = model_pack_path.removesuffix(".zip")
+            if os.path.exists(mpp):
+                self.is_legacy_model_pack = is_legacy_model_pack(mpp)
+            else:
+                # with medcat-den injected, can't have saved legacy model packs
+                self.is_legacy_model_pack = False
+        self.mct_export_paths = mct_export_paths
+        self.mct_export = self._load_mct_exports(self.mct_export_paths)
+        self.project_names: list[str] = []
+        self.document_names: list[str] = []
+        self.annotations = self._annotations()
+        self.model_pack_path = model_pack_path
+        if model_pack_path is not None:
+            if model_pack_path[-4:] == '.zip':
+                self.model_pack_path = model_pack_path[:-4]
+
+    def _add_to_list_if_not_last(self, in_list: list[str], new_item: str):
+        if not in_list:
+            in_list.append(new_item)
+        elif in_list[-1] != new_item:
+            in_list.append(new_item)
+
+    def _iter_anns(self, add_doc_names: bool = True,
+                   add_proj_names: bool = True
+                   ) -> Iterator[
+                       tuple[str, str, MedCATTrainerExportAnnotation]]:
+        for (proj_name, *_), doc, ann in iter_anns(self.mct_export):
+            doc_name = doc['name']
+            if add_proj_names:
+                self._add_to_list_if_not_last(self.project_names, proj_name)
+            if add_doc_names:
+                self._add_to_list_if_not_last(self.document_names, doc_name)
+            yield proj_name, doc_name, ann
+
+    def _annotations(self) -> list[AnnotationOutput]:
+        ann_lst = []
+        # reset project and document names
+        # in case of a second time calling _annotations()
+        # i.e if/when renaming meta annotations
+        self.project_names.clear()
+        self.document_names.clear()
+        for proj_name, doc_name, ann in self._iter_anns():
+            meta_anns_dict = dict()
+            if 'meta_anns' in ann:
+                _meta_anns = ann['meta_anns']  # type: ignore
+                meta_anns: list[dict]
+                if isinstance(_meta_anns, dict):
+                    meta_anns = list(_meta_anns.values())
+                elif isinstance(_meta_anns, list):
+                    meta_anns = list(_meta_anns)
+                elif not meta_anns:
+                    # allow empty
+                    pass
+                else:
+                    raise ValueError(f"Unknown meta anns: {meta_anns}")
+                for meta_ann in meta_anns:
+                    meta_anns_dict.update(
+                        {meta_ann['name']: meta_ann['value']})
+                _anns = ann.copy()
+                _anns.pop('meta_anns')  # type: ignore
+            output: AnnotationOutput = {
+                "project_name": proj_name,
+                "document_name": doc_name
+            }
+            output.update(_anns)  # type: ignore
+            output.update(meta_anns_dict)  # type: ignore
+            ann_lst.append(output)
+        return ann_lst
+
+    def _load_mct_exports(self, list_of_paths_to_mct_exports: list[str]
+                          ) -> _MedCATTrainerExport:
+        """
+        Loads a list of multiple MCT exports
+        :param list_of_paths_to_mct_exports: list of mct exports
+        :return: single json format object
+        """
+        mct_projects = []
+        for mct_project in list_of_paths_to_mct_exports:
+            with open(mct_project, 'r') as jsonfile:
+                mct_projects.extend(json.load(jsonfile)['projects'])
+        mct_proj_exports: _MedCATTrainerExport = {'projects': mct_projects}
+        return mct_proj_exports
+
+    def annotation_df(self) -> pd.DataFrame:
+        """
+        DataFrame of all annotations created
+        :return: DataFrame
+        """
+        annotation_df = pd.DataFrame(self.annotations)
+        if self.cat:
+            annotation_df.insert(
+                5, 'concept_name',
+                annotation_df['cui'].map(
+                    lambda cui: cast(CAT, self.cat).cdb.get_name(cui)))
+        exceptions: list[ValueError] = []
+        # try the default format as well as the format specified above
+        for format in [None, DATETIME_FORMAT]:
+            try:
+                annotation_df['last_modified'] = pd.to_datetime(
+                    annotation_df['last_modified'],
+                    format=format).dt.tz_localize(None)
+                exceptions.clear()
+                break
+            except ValueError as e:
+                exceptions.append(e)
+        if exceptions:
+            # if there's issues
+            raise ValueError(*exceptions)
+        return annotation_df
+
+    def concept_summary(self, extra_cui_filter: Optional[str] = None
+                        ) -> pd.DataFrame:
+        """
+        Summary of only correctly annotated concepts from a mct export
+        :return: DataFrame summary of annotations.
+        """
+        concept_output_raw = self.annotation_df()
+        concept_output_pre = concept_output_raw[
+            concept_output_raw['validated']]
+        concept_output = concept_output_pre[
+            (concept_output_pre['correct']) | (
+                concept_output_pre['alternative'])]
+        if self.cat:
+            concept_count = concept_output.groupby(
+                ['cui', 'concept_name']).agg({'value': set, 'id': 'count'})
+        else:
+            concept_count = concept_output.groupby(
+                ['cui']).agg({'value': set, 'id': 'count'})
+        concept_count_df = pd.DataFrame(concept_count).reset_index(drop=False)
+        concept_count_df['variations'] = concept_count_df['value'].apply(
+            lambda x: len(x))
+        concept_count_df.rename({'id': 'concept_count'}, axis=1, inplace=True)
+        concept_count_df = concept_count_df.sort_values(
+            by='concept_count', ascending=False).reset_index(drop=True)
+        concept_count_df['count_variations_ratio'] = round(
+            concept_count_df['concept_count'] /
+            concept_count_df['variations'], 3)
+        if self.cat:
+            fps, fns, tps, cui_prec, cui_rec, cui_f1, cui_counts, examples = (
+                get_stats(self.cat, data=self.mct_export,  # type: ignore
+                          use_project_filters=True,
+                          # extra_cui_filter=extra_cui_filter
+                          ))
+            concept_count_df['fps'] = concept_count_df['cui'].map(fps)
+            concept_count_df['fns'] = concept_count_df['cui'].map(fns)
+            concept_count_df['tps'] = concept_count_df['cui'].map(tps)
+            concept_count_df['cui_prec'] = concept_count_df[
+                'cui'].map(cui_prec)
+            concept_count_df['cui_rec'] = concept_count_df['cui'].map(cui_rec)
+            concept_count_df['cui_f1'] = concept_count_df['cui'].map(cui_f1)
+            # concept_count_df['cui_counts'] = # TODO check why cui counts is
+            #                                    incorrect
+            #    concept_count_df['cui'].map(cui_counts)
+            examples_df = pd.DataFrame(
+                examples).rename_axis('cui').reset_index(drop=False).\
+                rename(columns={'fp': 'fp_examples',
+                                'fn': 'fn_examples',
+                                'tp': 'tp_examples'})
+            concept_count_df = concept_count_df.merge(
+                examples_df, how='left', on='cui')
+
+        return concept_count_df
+
+    def user_stats(self, by_user: bool = True) -> pd.DataFrame:
+        """
+        Summary of user annotation work done
+
+        :param by_user: User Stats grouped by user rather than day
+        :return: DataFrame of user annotation work done
+        """
+        df = self.annotation_df()[['user', 'last_modified']]
+        data = df.groupby([df['last_modified'].dt.year.rename('year'),
+                           df['last_modified'].dt.month.rename('month'),
+                           df['last_modified'].dt.day.rename('day'),
+                           df['user']]).agg({'count'})  # type: ignore
+        data = pd.DataFrame(data)
+        data.columns = data.columns.droplevel()
+        data = data.reset_index(drop=False)
+        data['date'] = pd.to_datetime(data[['year', 'month', 'day']])
+        if by_user:
+            data = data[['user', 'count']].groupby(by='user').agg(sum)
+            data = data.reset_index(drop=False).sort_values(
+                by='count', ascending=False).reset_index(drop=True)
+            return data
+        return data[['user', 'count', 'date']]
+
+    def plot_user_stats(self, save_fig: bool = False,
+                        save_fig_filename: str = ''):
+        """
+        Plot annotator user stats against time.
+        An alternative method of saving the file is:
+            plot_user_stats().write_image("path/filename.png")
+        :param save_fig: Optional parameter to save the plot
+        :param save_fig_filename: path/filename.html, default value is
+            mct export projects names.
+        :return: fig object
+        """
+        data = self.user_stats(by_user=False)
+        total_annotations = data['count'].sum()
+        fig = go.Figure()
+        for user in data['user'].unique():
+            fig.add_trace(
+                go.Bar(x=data[data['user'] == user]['date'],
+                       y=data[data['user'] == user]['count'], name=user),
+            )
+        fig.update_layout(title={'text': 'MedCATtrainer Annotator Progress - '
+                                 f'Total annotations: {total_annotations}'},
+                          legend_title_text='MedCAT Annotator',
+                          barmode='stack')
+        fig.update_xaxes(title_text='Date')
+        fig.update_yaxes(title_text='Annotation Count')
+        if save_fig:
+            if save_fig_filename:
+                filename = save_fig_filename
+            else:
+                filename = input("Please enter the export path/filename "
+                                 "with no ext: ") + '.html'
+            plotly.offline.plot(fig, filename=filename)
+            print(f'The figure was saved at: {filename}')
+        return fig
+
+    def _rename_meta_ann_values(self, meta_anns: dict[str, dict[str, str]],
+                                name_replacement: str,
+                                meta_ann_name: str,
+                                meta_values: dict[str, str],
+                                meta_ann_values2rename: dict[
+                                    str, dict[str, str]]):
+        if meta_anns[name_replacement]['name'] == meta_ann_name:
+            for value in meta_values:
+                if meta_anns[name_replacement]['value'] == value:
+                    meta_anns[name_replacement]['value'] = (
+                        meta_ann_values2rename[meta_ann_name][value])
+
+    def _rename_meta_ann_for_name(
+            self, meta_anns: dict[str, dict[str, str]],
+            name2replace: str,
+            name_replacement: str,
+            meta_ann_values2rename: dict[str, dict[str, str]]):
+        meta_anns[name_replacement] = meta_anns.pop(name2replace)
+        meta_anns[name_replacement]['name'] = name_replacement
+        for meta_ann_name, meta_values in meta_ann_values2rename.items():
+            self._rename_meta_ann_values(
+                meta_anns, name_replacement, meta_ann_name, meta_values,
+                meta_ann_values2rename)
+
+    def _rename_meta_ann(
+            self, meta_anns: dict[str, dict[str, str]],
+            meta_anns2rename: dict[str, str] = dict(),
+            meta_ann_values2rename: dict[str, dict[str, str]] = dict()):
+        for meta_name2replace in meta_anns2rename:
+            try:
+                self._rename_meta_ann_for_name(
+                    meta_anns, meta_name2replace,
+                    meta_anns2rename[meta_name2replace],
+                    meta_ann_values2rename)
+            except KeyError:
+                pass
+
+    def rename_meta_anns(
+            self, meta_anns2rename: dict[str, str] = dict(),
+            meta_ann_values2rename: dict[str, dict[str, str]] = dict()):
+        """Rename the names and/or values of meta annotations.
+
+        :param meta_anns2rename: Example input:
+            `{'Subject/Experiencer': 'Subject'}`
+        :param meta_ann_values2rename: Example input:
+            `{'Subject':{'Relative':'Other'}}`
+        :return:
+        """
+        # if we want to rename the values, but haven't specified any names
+        # to rename we need to use a names dict to map the names to themselves
+        # due to the way the current implementation works
+        if meta_ann_values2rename and not meta_anns2rename:
+            meta_anns2rename = dict((name, name) for name in
+                                    meta_ann_values2rename)
+        for _, _, ann in self._iter_anns(False, False):
+            if 'meta_anns' in ann:
+                _meta_anns = ann['meta_anns']  # type: ignore
+                meta_anns: dict[str, dict[str, str]]
+                if isinstance(_meta_anns, list):
+                    meta_anns = {ma['name']: ma
+                                 for ma in _meta_anns}
+                else:
+                    meta_anns = _meta_anns
+                if len(meta_anns) > 0:
+                    self._rename_meta_ann(
+                        meta_anns, meta_anns2rename, meta_ann_values2rename)
+        self.annotations = self._annotations()
+        return
+
+    def _eval_model(self, model: nn.Module,
+                    data: list[tuple[list[int], int, Optional[int]]],
+                    config: ConfigMetaCAT, tokenizer: TokenizerWrapperBase
+                    ) -> dict:
+        device = torch.device(config.general.device)  # Create a torch device
+        batch_size_eval = config.general.batch_size_eval
+        pad_id = config.model.padding_idx
+        ignore_cpos = config.model.ignore_cpos
+        class_weights = config.train.class_weights
+
+        if class_weights is not None:
+            class_weights = torch.FloatTensor(class_weights).to(device)
+            # Set the criterion to Cross Entropy Loss
+            criterion = nn.CrossEntropyLoss(weight=class_weights)
+        else:
+            # Set the criterion to Cross Entropy Loss
+            criterion = nn.CrossEntropyLoss()
+
+        # y_eval = [x[2] for x in data]
+        num_batches = math.ceil(len(data) / batch_size_eval)
+        running_loss = []
+        all_logits = []
+        model.to(device)
+        model.eval()
+
+        with torch.no_grad():
+            for i in range(num_batches):
+                x, cpos, y = create_batch_piped_data(data,
+                                                     i*batch_size_eval,
+                                                     (i+1)*batch_size_eval,
+                                                     device=device,
+                                                     pad_id=pad_id)
+                logits = model(x, cpos, ignore_cpos=ignore_cpos)
+                loss = criterion(logits, y)
+
+                # Track loss and logits
+                running_loss.append(loss.item())
+                all_logits.append(logits.detach().cpu().numpy())
+
+        predictions = np.argmax(np.concatenate(all_logits, axis=0), axis=1)
+        return predictions
+
+    def _eval(self,
+              metacat_model: MetaCAT,
+              mct_export: _MedCATTrainerExport
+              ) -> MetaAnnotationPredictions:
+        g_config = metacat_model.config.general
+        t_config = metacat_model.config.train
+        t_config.test_size = 0
+        t_config.shuffle_data = False
+        t_config.prerequisites = {}
+        t_config.cui_filter = set()
+
+        # Prepare the data
+        assert metacat_model.tokenizer is not None
+        data = prepare_from_json(
+            # NOTE: the method probably needs changing on lib side
+            cast(dict[str, Any], mct_export),
+            g_config.cntx_left,
+            g_config.cntx_right, metacat_model.tokenizer,
+            cui_filter=t_config.cui_filter,
+            replace_center=g_config.replace_center,
+            prerequisites=t_config.prerequisites,
+            lowercase=g_config.lowercase)
+
+        # Check is the name there
+        category_name = g_config.category_name
+        if category_name not in data:
+            warnings.warn(
+                f"The meta_model {category_name} does not exist in this "
+                "MedCATtrainer export.", UserWarning)
+            # NOTE: not to spec in terms of output
+            return {
+                category_name:  # type: ignore
+                f"{category_name} does not exist"
+                }  # type: ignore
+
+        data = data[category_name]
+
+        # We already have everything, just get the data
+        category_value2id = g_config.category_value2id
+        data, data_undersampled, category_values = encode_category_values(
+            data, existing_category_value2id=category_value2id)
+        print(category_values)
+        print(len(data))
+        # Run evaluation
+        assert metacat_model.tokenizer is not None
+        result = self._eval_model(
+            metacat_model.model, data, config=metacat_model.config,
+            tokenizer=metacat_model.tokenizer)
+
+        return {'predictions': result, 'meta_values': category_values}
+
+    def full_annotation_df(self) -> pd.DataFrame:
+        """
+        DataFrame of all annotations created including meta_annotation
+            predictions.
+        This function is similar to annotation_df with the addition of
+            Meta_annotation predictions from the medcat model.
+        prerequisite Args: MedcatTrainer_export([mct_export_paths],
+            model_pack_path=<path to medcat model>)
+        :return: DataFrame
+        """
+        # mostly for typing so mypu knows it's not None down below
+        if not self.cat or not self.model_pack_path:
+            raise ValueError("No model pack specified")
+        anns_df = self.annotation_df()
+        meta_df = anns_df[
+            (anns_df['validated']) & (not anns_df['deleted']) &
+            (not anns_df['killed']) & (not anns_df['irrelevant'])]
+        meta_df.reset_index(drop=True, inplace=True)
+
+        for meta_model_info in self.cat.get_model_card(
+                as_dict=True)['MetaCAT models']:
+            meta_model = meta_model_info['Category Name']
+            print(f'Checking metacat model: {meta_model}')
+            if self.is_legacy_model_pack:
+                _meta_model = get_meta_cat_from_old(
+                    self.model_pack_path + '/meta_' + meta_model,
+                    self.cat._pipeline._tokenizer)
+            else:
+                meta_model_path = os.path.join(
+                    self.model_pack_path, "saved_components",
+                    f"addon_meta_cat.{meta_model}")
+                # NOTE: the expected workflow when loading the model
+                #       is one where the config is stored as part of the
+                #       overall config and thus using it for loading is trivial
+                #       but here we need to manually load the config from disk
+                config_path = os.path.join(
+                    meta_model_path, "meta_cat", "config")
+                cnf: ConfigMetaCAT = deserialise(config_path)  # type: ignore
+                _meta_model = MetaCATAddon.load_existing(
+                    cnf, self.cat._pipeline._tokenizer, meta_model_path)
+            meta_cat = _meta_model.mc
+            meta_results = self._eval(meta_cat, self.mct_export)
+            _meta_values = {v: k for k, v in
+                            meta_results['meta_values'].items()}
+            pred_meta_values = []
+            counter = 0
+            for meta_value in meta_df[meta_model]:
+                if pd.isnull(meta_value):
+                    pred_meta_values.append(np.nan)
+                else:
+                    pred_meta_values.append(_meta_values.get(
+                        meta_results['predictions'][counter], np.nan))
+                    counter += 1
+
+            loc = meta_df.columns.get_loc(meta_model)
+            if isinstance(loc, int):
+                meta_df.insert(
+                    loc + 1, f'predict_{meta_model}', pred_meta_values)
+            else:
+                print(f"Warning: Unexpected column location type: {type(loc)}")
+            meta_df.insert(1, f'predict_{meta_model}', pred_meta_values)
+
+        return meta_df
+
+    def meta_anns_concept_summary(self) -> pd.DataFrame:
+        if not self.cat:
+            raise ValueError("No model pack specified")
+        meta_df = self.full_annotation_df()
+        meta_performance = {}
+        for cui in meta_df.cui.unique():
+            temp_meta_df = meta_df[meta_df['cui'] == cui]
+            meta_task_results = {}
+            for meta_task_info in self.cat.get_model_card(
+                    as_dict=True)['MetaCAT models']:
+                meta_task = meta_task_info['Category Name']
+                list_meta_anns = list(zip(
+                    temp_meta_df[meta_task],
+                    temp_meta_df['predict_' + meta_task]))
+                counter_meta_anns = Counter(list_meta_anns)
+                meta_value_results: dict[tuple[str, str, str],
+                                         Union[int, float]] = {}
+                # TODO: maybe make this easier?
+                meta_cats: list[MetaCATAddon] = [
+                    addon for addon in
+                    self.cat._pipeline.iter_addons()
+                    if (isinstance(addon, MetaCATAddon) and
+                        addon.config.comp_name == meta_task)
+                ]
+                if len(meta_cats) != 1:
+                    raise ValueError(
+                        f"Unable to uniquely identify meta task {meta_task}. "
+                        f"Found {len(meta_cats)} options")
+                meta_cat = meta_cats[0]
+                for meta_value in (
+                        meta_cat.config.general.category_value2id.keys()):
+                    total = 0
+                    fp = 0
+                    fn = 0
+                    tp = 0
+                    for meta_value_result, count in counter_meta_anns.items():
+                        if meta_value_result[0] == meta_value:
+                            if meta_value_result[1] == meta_value:
+                                tp += count
+                                total += count
+                            else:
+                                fn += count
+                                total += count
+                        elif meta_value_result[1] == meta_value:
+                            fp += count
+                        else:
+                            pass  # Skips nan values
+                    meta_value_results[
+                        (meta_task, meta_value, 'total')] = total
+                    meta_value_results[(meta_task, meta_value, 'fps')] = fp
+                    meta_value_results[(meta_task, meta_value, 'fns')] = fn
+                    meta_value_results[(meta_task, meta_value, 'tps')] = tp
+                    try:
+                        meta_value_results[(meta_task, meta_value, 'f-score')
+                                           ] = tp / (tp + (1 / 2) * (fp + fn))
+                    except ZeroDivisionError:
+                        meta_value_results[(meta_task, meta_value, 'f-score')
+                                           ] = 0
+                meta_task_results.update(meta_value_results)
+            meta_performance[cui] = meta_task_results
+
+        meta_anns_df = pd.DataFrame.from_dict(meta_performance, orient='index')
+        col_lst = []
+        for col in meta_anns_df.columns:
+            if col[2] == 'total':
+                col_lst.append(col)
+        meta_anns_df['total_anns'] = meta_anns_df[col_lst].sum(axis=1)
+        meta_anns_df = meta_anns_df.sort_values(
+            by='total_anns', ascending=False)
+        meta_anns_df = meta_anns_df.rename_axis('cui').reset_index(drop=False)
+        meta_anns_df.insert(1, 'concept_name', meta_anns_df['cui'].map(
+            lambda cui: cast(CAT, self.cat).cdb.get_name(cui)))
+        return meta_anns_df
+
+    def generate_report(self, path: str = 'mct_report.xlsx',
+                        meta_ann: bool = False,
+                        concept_filter: Optional[list] = None):
+        """
+        :param path: Outfile path
+        :param meta_ann: Include Meta_annotation evaluation in the summary
+            as well
+        :param concept_filter: Filter the report to only display select
+            concepts of interest. List of cuis.
+        :return: A full excel report for MedCATtrainer annotation work done.
+        """
+        if not self.cat:
+            raise ValueError("No model pack specified")
+        if concept_filter:
+            with pd.ExcelWriter(path) as writer:
+                print('Generating report...')
+                # array-like is allowed by documentation but not by typing
+                df = pd.DataFrame.from_dict([self.cat.get_model_card(
+                    as_dict=True)]).T.reset_index(drop=False)  # type: ignore
+                df.columns = [  # type: ignore
+                    'MCT report',
+                    f'Generated on {date.today().strftime("%Y/%m/%d")}']
+                df = pd.concat(
+                    [df, pd.DataFrame([['MCT Custom filter', concept_filter]],
+                                      columns=df.columns)],
+                    ignore_index=True)
+                df.to_excel(
+                    writer, index=False, sheet_name='medcat_model_card')
+                self.user_stats().to_excel(
+                    writer, index=False, sheet_name='user_stats')
+                print('Evaluating annotations...')
+                if meta_ann:
+                    ann_df = self.full_annotation_df()
+                    ann_df = ann_df[ann_df['cui'].isin(concept_filter)
+                                    ].reset_index(drop=True)
+                    # Remove timezone information
+                    ann_df['timestamp'] = ann_df[
+                        'timestamp'].dt.tz_localize(None)
+                    ann_df.to_excel(
+                        writer, index=False, sheet_name='annotations')
+                else:
+                    ann_df = self.annotation_df()
+                    ann_df = ann_df[ann_df['cui'].isin(concept_filter)
+                                    ].reset_index(drop=True)
+                    # Remove timezone information
+                    ann_df['timestamp'] = ann_df[
+                        'timestamp'].dt.tz_localize(None)
+                    ann_df.to_excel(writer, index=False,
+                                    sheet_name='annotations')
+                performance_summary_df = self.concept_summary()
+                performance_summary_df = performance_summary_df[
+                    performance_summary_df['cui'].isin(concept_filter)
+                    ].reset_index(drop=True)
+                performance_summary_df.to_excel(
+                    writer, index=False, sheet_name='concept_summary')
+                if meta_ann:
+                    print('Evaluating meta_annotations...')
+                    meta_anns_df = self.meta_anns_concept_summary()
+                    meta_anns_df = meta_anns_df[meta_anns_df['cui'].isin(
+                        concept_filter)].reset_index(drop=True)
+                    meta_anns_df.to_excel(
+                        writer, index=True,
+                        sheet_name='meta_annotations_summary')
+        else:
+            with pd.ExcelWriter(path) as writer:
+                print('Generating report...')
+                df = pd.DataFrame.from_dict(
+                    [self.cat.get_model_card(as_dict=True)]
+                    ).T.reset_index(drop=False)  # type: ignore
+                df.columns = [  # type: ignore
+                    'MCT report',
+                    f'Generated on {date.today().strftime("%Y/%m/%d")}']
+                df.to_excel(
+                    writer, index=False, sheet_name='medcat_model_card')
+                self.user_stats().to_excel(
+                    writer, index=False, sheet_name='user_stats')
+                print('Evaluating annotations...')
+                if meta_ann:
+                    self.full_annotation_df().to_excel(
+                        writer, index=False, sheet_name='annotations')
+                else:
+                    self.annotation_df().to_excel(
+                        writer, index=False, sheet_name='annotations')
+                self.concept_summary().to_excel(
+                    writer, index=False, sheet_name='concept_summary')
+                if meta_ann:
+                    print('Evaluating meta_annotations...')
+                    self.meta_anns_concept_summary().to_excel(
+                        writer, index=True,
+                        sheet_name='meta_annotations_summary')
+
+        return print(f"MCT report saved to: {path}")
diff --git a/medcat-scripts/evaluate_mct_export/mct_export_summary.ipynb b/medcat-scripts/evaluate_mct_export/mct_export_summary.ipynb
new file mode 100644
index 00000000..bb449f00
--- /dev/null
+++ b/medcat-scripts/evaluate_mct_export/mct_export_summary.ipynb
@@ -0,0 +1,356 @@
+{
+ "cells": [
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "metadata": {},
+   "source": [
+    "# Evaluate a MedCATtrainer project export\n",
+    "\n",
+    "Replace all values below a `# CHANGE THIS` comment with a custom name that refers to a file name."
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "6af34670",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "from mct_analysis import MedcatTrainer_export\n",
+    "from medcat_den.injection import inject_into_medcat\n",
+    "from medcat_den.den import get_default_den\n",
+    "from medcat_den.utils import summarise_den\n",
+    "# perform injection\n",
+    "inject_into_medcat(inject_save=True)\n",
+    "# to see available models\n",
+    "print(summarise_den(get_default_den()))"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "1beedf11",
+   "metadata": {},
+   "source": [
+    "## Load MCT exports and MedCAT model"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "2925541e",
+   "metadata": {
+    "scrolled": true
+   },
+   "outputs": [],
+   "source": [
+    "lst_mct_export=[\n",
+    "    # CHANGE THIS\n",
+    "    '../data/mct_exports/example_mct_export.json', # mct_export .json here\n",
+    "               ]\n",
+    "\n",
+    "# CHANGE THIS\n",
+    "mct_model = \"a645742030cae7be\" # Enter your medcat model here\n",
+    "\n",
+    "\n",
+    "mct = MedcatTrainer_export(mct_export_paths=lst_mct_export, model_pack_path=mct_model)\n",
+    "# You can just jump to the generate the report section. The following code is a breakdown of the intermediate steps"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "f8750386",
+   "metadata": {},
+   "source": [
+    "# Evaluate model card"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "10d0ae54",
+   "metadata": {
+    "scrolled": true
+   },
+   "outputs": [],
+   "source": [
+    "# Load the model card\n",
+    "mct.cat.get_model_card(as_dict=True)"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "a02173f3",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# look to potentially remove any filters that exist in the model\n",
+    "\"\"\"\n",
+    "mct.cat.config.linking['filters']\n",
+    "\"\"\""
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "a1d9e264",
+   "metadata": {},
+   "source": [
+    "# Evaluate MCT export"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "1b1438ac",
+   "metadata": {},
+   "source": [
+    "### View all Annotations and Meta-annotations created"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "dbc6e8c1",
+   "metadata": {
+    "scrolled": false
+   },
+   "outputs": [],
+   "source": [
+    "# Load all annotations created\n",
+    "anns_df = mct.annotation_df()\n",
+    "anns_df"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "c0c09408",
+   "metadata": {},
+   "source": [
+    "### Summarise all Meta-annotations"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "365e0d9b",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# Meta_annotation summary\n",
+    "for col in anns_df.loc[:,'acc':].iloc[:,1:]:\n",
+    "    print(anns_df[col].value_counts())\n",
+    "    print()"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "c878d1e5",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# Meta_annotation summary of combinations\n",
+    "for k,v in anns_df.loc[:,'acc':].iloc[:,1:].value_counts().items():\n",
+    "    print(k,v)"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "3671903a",
+   "metadata": {},
+   "source": [
+    "### Overview of the entire MCT export\n",
+    "This includes all names of all projects within the export and the document ids."
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "dbafce9c",
+   "metadata": {
+    "scrolled": true
+   },
+   "outputs": [],
+   "source": [
+    "# projects\n",
+    "anns_df['project_name'].unique()"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "cd037b1a",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# documents\n",
+    "anns_df['document_name'].unique()"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "id": "c1f4e69f",
+   "metadata": {},
+   "source": [
+    "# Annotation Summary"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "fb49a72c",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "performance_summary_df = mct.concept_summary()"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {
+    "scrolled": true
+   },
+   "outputs": [],
+   "source": [
+    "performance_summary_df"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "metadata": {},
+   "source": [
+    "# Annotator stats"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# User Stats\n",
+    "mct.user_stats()"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "mct.plot_user_stats(save_fig=True, save_fig_filename='<<<user_mct_annotations>>>.html')"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "metadata": {},
+   "source": [
+    "# Generate report\n",
+    "All of the above functions added into a single Excel file report"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# Example of function description and parameters\n",
+    "help(mct.generate_report)"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {
+    "scrolled": true
+   },
+   "outputs": [],
+   "source": [
+    "mct.generate_report(path='<<<mct_report>>>.xlsx')"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {},
+   "outputs": [],
+   "source": []
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "metadata": {},
+   "source": [
+    "# Meta Annotations\n",
+    "\n",
+    "helper function to rename meta_task and meta_task values.\n",
+    "\n",
+    "__TODO:__  This Section is incomplete"
+   ]
+  },
+  {
+   "attachments": {},
+   "cell_type": "markdown",
+   "metadata": {},
+   "source": [
+    "### Rename meta annotation tasks"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# select which meta tasks to rename\n",
+    "rename_meta_anns = {'Subject/Experiencer':'Subject'}\n",
+    "# select which meta values for the corresponding meta tasks.\n",
+    "rename_meta_anns_values = {'Subject':{'Relative':'Other'}}\n",
+    "# run the renaming\n",
+    "mct.rename_meta_anns(meta_anns2rename=rename_meta_anns, meta_ann_values2rename=rename_meta_anns_values)"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "anns_df = mct.annotation_df()\n",
+    "anns_df.head()"
+   ]
+  }
+ ],
+ "metadata": {
+  "kernelspec": {
+   "display_name": ".venv",
+   "language": "python",
+   "name": "python3"
+  },
+  "language_info": {
+   "codemirror_mode": {
+    "name": "ipython",
+    "version": 3
+   },
+   "file_extension": ".py",
+   "mimetype": "text/x-python",
+   "name": "python",
+   "nbconvert_exporter": "python",
+   "pygments_lexer": "ipython3",
+   "version": "3.11.12"
+  }
+ },
+ "nbformat": 4,
+ "nbformat_minor": 5
+}
diff --git a/medcat-scripts/finetune_models/finetune_models.ipynb b/medcat-scripts/finetune_models/finetune_models.ipynb
new file mode 100644
index 00000000..06674b97
--- /dev/null
+++ b/medcat-scripts/finetune_models/finetune_models.ipynb
@@ -0,0 +1,375 @@
+{
+ "cells": [
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "e1e224c0",
+   "metadata": {},
+   "outputs": [
+    {
+     "name": "stdout",
+     "output_type": "stream",
+     "text": [
+      "Den (LOCAL_USER) with 3 models:\n",
+      "a645742030cae7be ('No description\\n[27 August 2025] BASE MODEL - FAKE')\n",
+      " - History: ['a645742030cae7be']\n",
+      " - Source ontologies: ['FAKE-ONT']\n",
+      " - Meta models: []\n",
+      " - MedCAT Version: 2.0.0\n",
+      " - Last updated: 2025-08-27T14:19:48.479156\n",
+      "cbbc516986aa8e30 ('No description\\n[27 August 2025] BASE MODEL - FAKE\\n[27 August 2025] Additional-fake-data-trained')\n",
+      " - History: ['a645742030cae7be', 'cbbc516986aa8e30']\n",
+      " - Source ontologies: ['FAKE-ONT']\n",
+      " - Meta models: []\n",
+      " - MedCAT Version: 2.0.0\n",
+      " - Last updated: 2025-08-27T14:25:22.993770\n",
+      "2d99c0efac4d5af7 ('N/A\\n[02 September 2025] Brand New Base Model\\n[02 September 2025] Empty Model w 2d99c0efac4d5af7')\n",
+      " - History: ['2d99c0efac4d5af7']\n",
+      " - Source ontologies: []\n",
+      " - Meta models: []\n",
+      " - MedCAT Version: 2.0.0\n",
+      " - Last updated: 2025-09-02T12:39:23.477744\n"
+     ]
+    }
+   ],
+   "source": [
+    "from medcat_den.injection import inject_into_medcat\n",
+    "from medcat_den.den import get_default_den\n",
+    "from medcat_den.utils import summarise_den\n",
+    "# NOTE: this will centralise model storage and\n",
+    "#       allow using the centralise storage automatically\n",
+    "inject_into_medcat(inject_save=True)\n",
+    "# to see available models\n",
+    "print(summarise_den(get_default_den()))\n",
+    "from medcat.cat import CAT\n",
+    "from medcat.stats import get_stats\n",
+    "import json\n"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "8e59aefd",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# input data \n",
+    "\n",
+    "# make sure the export is in this folder\n",
+    "ann_dir = \"../data/mct_exports/\"\n",
+    "# CHANGE THIS:\n",
+    "mctrainer_export_name = \"example_mct_export.json\" \n",
+    "\n",
+    "mctrainer_export_path = ann_dir + mctrainer_export_name\n",
+    "\n",
+    "# CHANGE THIS:\n",
+    "model_hash = 'a645742030cae7be'\n",
+    "\n",
+    "# CHANGE THIS [optional]:\n",
+    "output_model_name = f\"{model_hash}_trained_model\"\n",
+    "\n",
+    "# Add training filter if needed\n",
+    "snomed_filter_path = None  # path to snomed filter"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 5,
+   "id": "f53a222b",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "\n",
+    "# Create CAT - the main class from medcat used for concept annotation\n",
+    "cat = CAT.load_model_pack(model_hash)  # NOTE: loads from den automatically\n",
+    "cat.config.components.linking.filters.cuis = set()  # To remove exisitng filters\n"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "1c4c72d9",
+   "metadata": {},
+   "source": [
+    "# Set filter\n",
+    "\n",
+    "Setting a filter will speed up training time since it will only train the concepts you're interested in."
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 6,
+   "id": "45f8806a",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# Add extra training filter if required.\n",
+    "if snomed_filter_path:\n",
+    "    snomed_filter = set(json.load(open(snomed_filter_path)))\n",
+    "else:\n",
+    "    snomed_filter = set(cat.cdb.cui2info.keys())"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "51053394",
+   "metadata": {},
+   "source": [
+    "# Train"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 10,
+   "id": "6a6ced81",
+   "metadata": {},
+   "outputs": [
+    {
+     "name": "stderr",
+     "output_type": "stream",
+     "text": [
+      "Epoch:   0%|          | 0/3 [00:00<?, ?it/s]\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "Epoch:  33%|███▎      | 1/3 [00:03<00:06,  3.14s/it]\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "Epoch:  67%|██████▋   | 2/3 [00:06<00:03,  3.02s/it]\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "\u001b[A\n",
+      "                                                    \r"
+     ]
+    },
+    {
+     "data": {
+      "text/plain": [
+       "({}, {}, {}, {}, {}, {}, {}, {})"
+      ]
+     },
+     "execution_count": 10,
+     "metadata": {},
+     "output_type": "execute_result"
+    }
+   ],
+   "source": [
+    "with open(mctrainer_export_path) as f:\n",
+    "    data = json.load(f)\n",
+    "cat.trainer.train_supervised_raw(\n",
+    "    data=data, \n",
+    "    nepochs=3,\n",
+    "    reset_cui_count=False,\n",
+    "    print_stats=True,\n",
+    "    use_filters=True,\n",
+    "    extra_cui_filter=snomed_filter,  # If not filter is set remove this line\n",
+    ")"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "64514ea1",
+   "metadata": {},
+   "source": [
+    "# Stats"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 13,
+   "id": "eccc3358",
+   "metadata": {},
+   "outputs": [
+    {
+     "name": "stderr",
+     "output_type": "stream",
+     "text": [
+      "                                                            "
+     ]
+    },
+    {
+     "name": "stdout",
+     "output_type": "stream",
+     "text": [
+      "Epoch: 0, Prec: 0.7795454545454545, Rec: 0.8511166253101737, F1: 0.8137603795966786\n",
+      "\n",
+      "Docs with false positives: 1734; 611; 879; 485; 1605; 1377; 716; 1881; 496; 641\n",
+      "\n",
+      "Docs with false negatives: 1734; 611; 879; 1605; 1377; 716; 1881; 496; 641; 898\n",
+      "\n",
+      "\n",
+      "\n",
+      "False Positives\n",
+      "\n",
+      "high~blood~pressure                                                    - C0020538             -         20\n",
+      "fever                                                                  - C03                  -         17\n",
+      "syndrome                                                               - C0039082             -         15\n",
+      "alcohol~abuse                                                          - C0085762             -         10\n",
+      "cardiovascular                                                         - C1301700             -          8\n",
+      "cardiac                                                                - C0018801             -          6\n",
+      "deficits                                                               - C0009241             -          5\n",
+      "obesity                                                                - C0028754             -          5\n",
+      "fittest                                                                - C05                  -          3\n",
+      "seizure                                                                - C04                  -          2\n",
+      "\n",
+      "\n",
+      "False Negatives\n",
+      "\n",
+      "skin~lesion                                                            - C0037284             -         14\n",
+      "diabete                                                                - C0011849             -         10\n",
+      "diabete                                                                - C0011860             -          8\n",
+      "ashd                                                                   - C0010054             -          7\n",
+      "stroke                                                                 - C0038454             -          3\n",
+      "infection                                                              - C0854135             -          3\n",
+      "pulmonary~embolus                                                      - C0034065             -          3\n",
+      "coronary~artery~disease                                                - C0010068             -          2\n",
+      "infection                                                              - C0276289             -          2\n",
+      "type~1                                                                 - C0011854             -          2\n",
+      "\n",
+      "\n",
+      "True Positives\n",
+      "\n",
+      "high~blood~pressure                                                    - C0020538             -         43\n",
+      "hyperlipidemia                                                         - C0020473             -         12\n",
+      "lymphadenopathy                                                        - C0497156             -         10\n",
+      "depressed                                                              - C0011570             -         10\n",
+      "erythematous                                                           - C0041834             -          9\n",
+      "congestive~heart~failure                                               - C0018802             -          8\n",
+      "skin~lesion                                                            - C0037284             -          7\n",
+      "chronic~obstructive~pulmonary~disease                                  - C0024117             -          7\n",
+      "anemia                                                                 - C0002871             -          7\n",
+      "renal~insufficiency                                                    - C1565489             -          7\n",
+      "**************************************************************************************************************\n",
+      "\n"
+     ]
+    },
+    {
+     "name": "stderr",
+     "output_type": "stream",
+     "text": [
+      "\r"
+     ]
+    }
+   ],
+   "source": [
+    "fps, fns, tps, cui_prec, cui_rec, cui_f1, cui_counts, examples = get_stats(cat, data, use_project_filters=True)\n"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 16,
+   "id": "81f76a8d",
+   "metadata": {},
+   "outputs": [
+    {
+     "name": "stdout",
+     "output_type": "stream",
+     "text": [
+      "1.0 1.0 1.0\n"
+     ]
+    }
+   ],
+   "source": [
+    "cui = \"C0004096\" # Asthma\n",
+    "print(cui_f1[cui], cui_prec[cui], cui_rec[cui])"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "61958a4e",
+   "metadata": {},
+   "source": [
+    "# Seve model"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "4060101f",
+   "metadata": {},
+   "outputs": [
+    {
+     "name": "stderr",
+     "output_type": "stream",
+     "text": [
+      "/Users/martratas/Documents/CogStack/.MedCAT.nosync/cogstack-ops/medcat-scripts/.venv/lib/python3.11/site-packages/tqdm/auto.py:21: TqdmWarning: IProgress not found. Please update jupyter and ipywidgets. See https://ipywidgets.readthedocs.io/en/stable/user_install.html\n",
+      "  from .autonotebook import tqdm as notebook_tqdm\n"
+     ]
+    }
+   ],
+   "source": [
+    "# you can save centrally (since tihs is injected) with\n",
+    "cat.save_model_pack(f\"Fine-tuned with {mctrainer_export_name}\")"
+   ]
+  }
+ ],
+ "metadata": {
+  "kernelspec": {
+   "display_name": ".venv",
+   "language": "python",
+   "name": "python3"
+  },
+  "language_info": {
+   "codemirror_mode": {
+    "name": "ipython",
+    "version": 3
+   },
+   "file_extension": ".py",
+   "mimetype": "text/x-python",
+   "name": "python",
+   "nbconvert_exporter": "python",
+   "pygments_lexer": "ipython3",
+   "version": "3.11.12"
+  }
+ },
+ "nbformat": 4,
+ "nbformat_minor": 5
+}
diff --git a/medcat-scripts/mypy.ini b/medcat-scripts/mypy.ini
new file mode 100644
index 00000000..14d849c8
--- /dev/null
+++ b/medcat-scripts/mypy.ini
@@ -0,0 +1,2 @@
+[mypy-plotly.*]
+ignore_missing_imports = True
diff --git a/medcat-scripts/requirements-dev.txt b/medcat-scripts/requirements-dev.txt
new file mode 100644
index 00000000..65cceb5a
--- /dev/null
+++ b/medcat-scripts/requirements-dev.txt
@@ -0,0 +1,9 @@
+mypy
+pytest
+pytest-xdist
+nbmake<1.5
+nbconvert<6
+jupyter-client
+ipykernel
+plotly-stubs; python_version >= '3.10'
+pandas-stubs
\ No newline at end of file
diff --git a/medcat-scripts/requirements.txt b/medcat-scripts/requirements.txt
new file mode 100644
index 00000000..4c162ba7
--- /dev/null
+++ b/medcat-scripts/requirements.txt
@@ -0,0 +1,5 @@
+medcat[spacy,deid,meta-cat,rel-cat]~=2.1.0
+medcat-den
+ipython
+plotly
+openpyxl
\ No newline at end of file
diff --git a/medcat-scripts/run_models/run_model.ipynb b/medcat-scripts/run_models/run_model.ipynb
new file mode 100644
index 00000000..f3614d56
--- /dev/null
+++ b/medcat-scripts/run_models/run_model.ipynb
@@ -0,0 +1,133 @@
+{
+ "cells": [
+  {
+   "cell_type": "code",
+   "execution_count": null,
+   "id": "54df1496",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "import os\n",
+    "from run_model import run_model\n",
+    "from medcat_den.injection import inject_into_medcat\n",
+    "from medcat_den.den import get_default_den\n",
+    "from medcat_den.utils import summarise_den\n",
+    "# NOTE: this will centralise model storage and\n",
+    "#       allow using the centralise storage automatically\n",
+    "inject_into_medcat(inject_save=True)\n",
+    "# to see available models\n",
+    "print(summarise_den(get_default_den()))"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "191b18f6",
+   "metadata": {},
+   "source": [
+    "# Setup paths"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 2,
+   "id": "3a82f4d1",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# the model hash\n",
+    "# CHANGE THIS:\n",
+    "model_hash = \"a645742030cae7be\"\n",
+    "# projet name\n",
+    "# CHANGE THIS:\n",
+    "project_name = \"Example_Project\"\n",
+    "# output will be saved here\n",
+    "ann_dir_parent = \"../data/annotated_docs/\"\n",
+    "ann_dir = ann_dir_parent + project_name\n",
+    "if not os.path.exists(ann_dir):\n",
+    "    os.makedirs(ann_dir)\n",
+    "# CHANGE THIS (to a string):\n",
+    "snomed_filter_path = None"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "e4aa194f",
+   "metadata": {},
+   "source": [
+    "# Get the date stream"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 3,
+   "id": "94030087",
+   "metadata": {},
+   "outputs": [],
+   "source": [
+    "# Now it's time to get he data stream\n",
+    "# you may have existing data somewhere\n",
+    "# or you can use ElasticSearch to get it from CogStack (using cogstack.py / search_template.ipynb)\n",
+    "data_input = [\"Some data that talks about kidney failure in acute and chronic settings\",\n",
+    "              \"And perhaps an epileptic fit as well\"]"
+   ]
+  },
+  {
+   "cell_type": "markdown",
+   "id": "c24a0251",
+   "metadata": {},
+   "source": [
+    "# Run model"
+   ]
+  },
+  {
+   "cell_type": "code",
+   "execution_count": 4,
+   "id": "30f48c91",
+   "metadata": {},
+   "outputs": [
+    {
+     "ename": "ValueError",
+     "evalue": "Provided model pack path is not a directory: a645742030cae7be",
+     "output_type": "error",
+     "traceback": [
+      "\u001b[31m---------------------------------------------------------------------------\u001b[39m",
+      "\u001b[31mValueError\u001b[39m                                Traceback (most recent call last)",
+      "\u001b[36mCell\u001b[39m\u001b[36m \u001b[39m\u001b[32mIn[4]\u001b[39m\u001b[32m, line 1\u001b[39m\n\u001b[32m----> \u001b[39m\u001b[32m1\u001b[39m \u001b[43mrun_model\u001b[49m\u001b[43m(\u001b[49m\u001b[43mmodel_hash\u001b[49m\u001b[43m,\u001b[49m\n\u001b[32m      2\u001b[39m \u001b[43m          \u001b[49m\u001b[43mdata_input\u001b[49m\u001b[43m,\u001b[49m\n\u001b[32m      3\u001b[39m \u001b[43m          \u001b[49m\u001b[43msave_dir_path\u001b[49m\u001b[43m=\u001b[49m\u001b[43mann_dir\u001b[49m\u001b[43m,\u001b[49m\n\u001b[32m      4\u001b[39m \u001b[43m          \u001b[49m\u001b[43msnomed_filter_path\u001b[49m\u001b[43m=\u001b[49m\u001b[43msnomed_filter_path\u001b[49m\u001b[43m,\u001b[49m\n\u001b[32m      5\u001b[39m \u001b[43m          \u001b[49m\u001b[43mn_process\u001b[49m\u001b[43m=\u001b[49m\u001b[32;43m1\u001b[39;49m\u001b[43m)\u001b[49m\n",
+      "\u001b[36mFile \u001b[39m\u001b[32m~/Documents/CogStack/.MedCAT.nosync/cogstack-ops/medcat-scripts/run_models/run_model.py:17\u001b[39m, in \u001b[36mrun_model\u001b[39m\u001b[34m(model_hash_or_path, data, save_dir_path, snomed_filter_path, n_process)\u001b[39m\n\u001b[32m     12\u001b[39m \u001b[38;5;28;01mdef\u001b[39;00m\u001b[38;5;250m \u001b[39m\u001b[34mrun_model\u001b[39m(model_hash_or_path: \u001b[38;5;28mstr\u001b[39m, data: \u001b[38;5;28mlist\u001b[39m[\u001b[38;5;28mstr\u001b[39m],\n\u001b[32m     13\u001b[39m               save_dir_path: \u001b[38;5;28mstr\u001b[39m,\n\u001b[32m     14\u001b[39m               snomed_filter_path: Optional[\u001b[38;5;28mstr\u001b[39m] = \u001b[38;5;28;01mNone\u001b[39;00m,\n\u001b[32m     15\u001b[39m               n_process: \u001b[38;5;28mint\u001b[39m = \u001b[32m1\u001b[39m,\n\u001b[32m     16\u001b[39m               ):\n\u001b[32m---> \u001b[39m\u001b[32m17\u001b[39m     cat = \u001b[43mCAT\u001b[49m\u001b[43m.\u001b[49m\u001b[43mload_model_pack\u001b[49m\u001b[43m(\u001b[49m\u001b[43mmodel_hash_or_path\u001b[49m\u001b[43m)\u001b[49m\n\u001b[32m     18\u001b[39m     \u001b[38;5;28;01mif\u001b[39;00m snomed_filter_path:\n\u001b[32m     19\u001b[39m         \u001b[38;5;28;01mwith\u001b[39;00m \u001b[38;5;28mopen\u001b[39m(snomed_filter_path) \u001b[38;5;28;01mas\u001b[39;00m f:\n",
+      "\u001b[36mFile \u001b[39m\u001b[32m~/Documents/CogStack/.MedCAT.nosync/cogstack-ops/medcat-scripts/.venv/lib/python3.11/site-packages/medcat/cat.py:711\u001b[39m, in \u001b[36mCAT.load_model_pack\u001b[39m\u001b[34m(cls, model_pack_path, config_dict, addon_config_dict)\u001b[39m\n\u001b[32m    708\u001b[39m     model_pack_path = \u001b[38;5;28mcls\u001b[39m.attempt_unpack(model_pack_path)\n\u001b[32m    709\u001b[39m logger.info(\u001b[33m\"\u001b[39m\u001b[33mAttempting to load model from file: \u001b[39m\u001b[38;5;132;01m%s\u001b[39;00m\u001b[33m\"\u001b[39m,\n\u001b[32m    710\u001b[39m             model_pack_path)\n\u001b[32m--> \u001b[39m\u001b[32m711\u001b[39m is_legacy = \u001b[43mis_legacy_model_pack\u001b[49m\u001b[43m(\u001b[49m\u001b[43mmodel_pack_path\u001b[49m\u001b[43m)\u001b[49m\n\u001b[32m    712\u001b[39m avoid_legacy = avoid_legacy_conversion()\n\u001b[32m    713\u001b[39m \u001b[38;5;28;01mif\u001b[39;00m is_legacy \u001b[38;5;129;01mand\u001b[39;00m \u001b[38;5;129;01mnot\u001b[39;00m avoid_legacy:\n",
+      "\u001b[36mFile \u001b[39m\u001b[32m~/Documents/CogStack/.MedCAT.nosync/cogstack-ops/medcat-scripts/.venv/lib/python3.11/site-packages/medcat/utils/legacy/identifier.py:17\u001b[39m, in \u001b[36mis_legacy_model_pack\u001b[39m\u001b[34m(model_pack_path)\u001b[39m\n\u001b[32m      8\u001b[39m \u001b[38;5;250m\u001b[39m\u001b[33;03m\"\"\"Check if the model pack is a legacy model pack.\u001b[39;00m\n\u001b[32m      9\u001b[39m \n\u001b[32m     10\u001b[39m \u001b[33;03mArgs:\u001b[39;00m\n\u001b[32m   (...)\u001b[39m\u001b[32m     14\u001b[39m \u001b[33;03m    bool: True if the model pack is a legacy model pack, False otherwise.\u001b[39;00m\n\u001b[32m     15\u001b[39m \u001b[33;03m\"\"\"\u001b[39;00m\n\u001b[32m     16\u001b[39m \u001b[38;5;28;01mif\u001b[39;00m \u001b[38;5;129;01mnot\u001b[39;00m os.path.isdir(model_pack_path):\n\u001b[32m---> \u001b[39m\u001b[32m17\u001b[39m     \u001b[38;5;28;01mraise\u001b[39;00m \u001b[38;5;167;01mValueError\u001b[39;00m(\n\u001b[32m     18\u001b[39m         \u001b[33mf\u001b[39m\u001b[33m\"\u001b[39m\u001b[33mProvided model pack path is not a directory: \u001b[39m\u001b[38;5;132;01m{\u001b[39;00mmodel_pack_path\u001b[38;5;132;01m}\u001b[39;00m\u001b[33m\"\u001b[39m)\n\u001b[32m     19\u001b[39m cdb_path_v1 = os.path.join(model_pack_path, EXPECTED_V1_CDB_FILE_NAME)\n\u001b[32m     20\u001b[39m cdb_path_v2 = os.path.join(model_pack_path, EXPECTED_V2_CDB_FOLDER_NAME)\n",
+      "\u001b[31mValueError\u001b[39m: Provided model pack path is not a directory: a645742030cae7be"
+     ]
+    }
+   ],
+   "source": [
+    "run_model(model_hash,\n",
+    "          data_input,\n",
+    "          save_dir_path=ann_dir,\n",
+    "          snomed_filter_path=snomed_filter_path,\n",
+    "          n_process=1)"
+   ]
+  }
+ ],
+ "metadata": {
+  "kernelspec": {
+   "display_name": ".venv",
+   "language": "python",
+   "name": "python3"
+  },
+  "language_info": {
+   "codemirror_mode": {
+    "name": "ipython",
+    "version": 3
+   },
+   "file_extension": ".py",
+   "mimetype": "text/x-python",
+   "name": "python",
+   "nbconvert_exporter": "python",
+   "pygments_lexer": "ipython3",
+   "version": "3.11.12"
+  }
+ },
+ "nbformat": 4,
+ "nbformat_minor": 5
+}
diff --git a/medcat-scripts/run_models/run_model.py b/medcat-scripts/run_models/run_model.py
new file mode 100644
index 00000000..89faee86
--- /dev/null
+++ b/medcat-scripts/run_models/run_model.py
@@ -0,0 +1,29 @@
+from typing import Optional
+from medcat.cat import CAT
+import json
+import os
+
+import logging
+medcat_logger = logging.getLogger('medcat')
+fh = logging.FileHandler('medcat.log')
+medcat_logger.addHandler(fh)
+
+
+def run_model(model_hash_or_path: str, data: list[str],
+              save_dir_path: str,
+              snomed_filter_path: Optional[str] = None,
+              n_process: int = 1,
+              ):
+    cat = CAT.load_model_pack(model_hash_or_path)
+    if snomed_filter_path:
+        with open(snomed_filter_path) as f:
+            snomed_filter = json.load(f)
+    else:
+        snomed_filter = set()  # no filter
+    cat.config.components.linking.filters.cuis = snomed_filter
+
+    if not os.path.exists(save_dir_path):
+        os.makedirs(save_dir_path)
+    list(cat.get_entities_multi_texts(
+        data, n_process=n_process,
+        save_dir_path=save_dir_path))
diff --git a/medcat-scripts/tests/evaluate_mct_export/test_mct_analysis.py b/medcat-scripts/tests/evaluate_mct_export/test_mct_analysis.py
new file mode 100644
index 00000000..f1ac09e1
--- /dev/null
+++ b/medcat-scripts/tests/evaluate_mct_export/test_mct_analysis.py
@@ -0,0 +1,184 @@
+
+import os
+import sys
+
+import pandas as pd
+
+import unittest
+
+
+_FILE_DIR = os.path.dirname(__file__)
+
+# because this project isn't (at least of of writing this)
+# set up as a python project, there are no __init__.py
+# files in each folder
+# as such, in order to gain access to the relevant module,
+# I'll need to add the path manually
+_ROOT_FOLDER = os.path.join(_FILE_DIR, "..", "..")
+MEDCAT_EVAL_MCT_EXPORT_FOLDER = os.path.abspath(
+    os.path.join(_ROOT_FOLDER, "evaluate_mct_export"))
+sys.path.append(MEDCAT_EVAL_MCT_EXPORT_FOLDER)
+# and now we can import from mct_analysis
+from mct_analysis import MedcatTrainer_export
+
+
+# add path to MCT export
+RESOURCE_DIR = os.path.abspath(os.path.join(_FILE_DIR, "..", "resources"))
+MCT_EXPORT_JSON_PATH = os.path.join(RESOURCE_DIR, "MCT_export_example.json")
+
+
+class MCTExportInitTests(unittest.TestCase):
+
+    def test_can_init(self):
+        inst = MedcatTrainer_export([MCT_EXPORT_JSON_PATH, ], None)
+        self.assertIsInstance(inst, MedcatTrainer_export)
+
+
+class BaseMCTExportTests(unittest.TestCase):
+
+    @classmethod
+    def setUpClass(cls) -> None:
+        cls.export = MedcatTrainer_export([MCT_EXPORT_JSON_PATH, ], None)
+
+    def assertNonEmptyDataframe(self, df):
+        self.assertIsInstance(df, pd.DataFrame)
+        self.assertFalse(df.empty)
+
+
+class MCTExportBasicTests(BaseMCTExportTests):
+
+    def test_can_get_annotations(self):
+        annotation_df = self.export.annotation_df()
+        self.assertNonEmptyDataframe(annotation_df)
+
+    def test_can_get_summary(self):
+        summary_df = self.export.concept_summary()
+        self.assertNonEmptyDataframe(summary_df)
+
+    def test_can_get_user_stats(self):
+        users_stats = self.export.user_stats()
+        self.assertNonEmptyDataframe(users_stats)
+
+    def test_can_rename_meta_anns_empty_no_change(self):
+        ann_df1 = self.export.annotation_df()
+        self.export.rename_meta_anns()
+        ann_df2 = self.export.annotation_df()
+        self.assertTrue(all(ann_df1 == ann_df2))
+
+
+class MCTExportUsageTests(BaseMCTExportTests):
+
+    def assertDataFrameHasRowsColumns(self, df,
+                                      exp_rows: int,
+                                      exp_columns: int):
+        self.assertEqual(len(df.index), exp_rows)
+        self.assertEqual(len(df.columns), exp_columns)
+
+    def test_has_correct_projects(self, exp_proj=['MartTestAnnotation']):
+        got = self.export.project_names
+        self.assertEqual(len(got), len(exp_proj))
+        self.assertEqual(got, exp_proj)
+
+    def test_has_correct_documents(self, exp_docs=[
+            'Doc 1', 'Doc 2', 'Doc 3', 'Doc 4', 'Doc 5']):
+        got = self.export.document_names
+        self.assertEqual(len(got), len(exp_docs))
+        self.assertEqual(got, exp_docs)
+
+    def test_rename_meta_anns_empty_does_not_add_project_and_doc_names(self):
+        self.export.rename_meta_anns()
+        self.test_has_correct_projects()
+        self.test_has_correct_documents()
+
+    def test_annotations_has_correct_rows_columns(self,
+                                                  exp_rows=362,
+                                                  exp_columns=19):
+        ann_df = self.export.annotation_df()
+        self.assertDataFrameHasRowsColumns(ann_df, exp_rows, exp_columns)
+
+    def test_summary_has_correct_rows_columns(self,
+                                              exp_rows=197,
+                                              exp_columns=5):
+        summary_df = self.export.concept_summary()
+        self.assertDataFrameHasRowsColumns(summary_df, exp_rows, exp_columns)
+
+    def test_cuser_stats_has_correct_rows_columns(self,
+                                                  exp_rows=1,
+                                                  exp_columns=2):
+        users_stats = self.export.user_stats()
+        self.assertDataFrameHasRowsColumns(users_stats, exp_rows, exp_columns)
+
+    def test_cuser_stats_has_correct_user(self, expected="mart"):
+        unique_users = self.export.user_stats()["user"].unique().tolist()
+        self.assertEqual(len(unique_users), 1)
+        self.assertEqual(unique_users[0], expected)
+
+
+class MCTExportMetaAnnRenameTests(unittest.TestCase):
+    NAMES2RENAME = {"Status": "VERSION"}
+    VALUES2RENAME = {"Status": {"Affirmed": "Got it!"}}
+    # can only rename values if renaming names
+    # so need a mapping from the same name to the same name
+    # for each name used in values
+    VALUES_RENAME_HELPER = dict((n, n) for n in VALUES2RENAME)
+
+    def setUp(self) -> None:
+        self.export = MedcatTrainer_export([MCT_EXPORT_JSON_PATH, ], None)
+
+    def _get_all_meta_anns(self):
+        for proj in self.export.mct_export['projects']:
+            for doc in proj['documents']:
+                for ann in doc['annotations']:
+                    for meta_ann in ann["meta_anns"].items():
+                        yield meta_ann
+
+    def _check_names(self, prev_anns: list):
+        for (meta_ann_name, _), (prev_name, _) in zip(
+                self._get_all_meta_anns(), prev_anns):
+            for name, replacement_name in self.NAMES2RENAME.items():
+                with self.subTest(
+                        f"{name} -> {replacement_name} ({meta_ann_name})"):
+                    self.assertNotEqual(meta_ann_name, name)
+                    if prev_name == name:
+                        self.assertEqual(meta_ann_name, replacement_name)
+
+    def test_meta_annotations_renamed_names(self):
+        prev_anns = list(self._get_all_meta_anns())
+        self.export.rename_meta_anns(meta_anns2rename=self.NAMES2RENAME)
+        self._check_names(prev_anns)
+
+    def _check_values(self, prev_anns: list, only_values: bool = True):
+        for (name, ann), (prev_name, prev_ann) in zip(
+                self._get_all_meta_anns(), prev_anns):
+            with self.subTest(f"{prev_ann} -> {ann}"):
+                if only_values:
+                    # if only changing values, not names themselves
+                    self.assertEqual(name, prev_name, "Names should not change")
+                for target_name, value_map in self.VALUES2RENAME.items():
+                    # if correct target and has a value that can be remapped
+                    if name == target_name and prev_ann["value"] in value_map:
+                        with self.subTest(f"{target_name} with {value_map}"):
+                            start_value = prev_ann["value"]
+                            new_value = ann["value"]
+                            exp_value = value_map[start_value]
+                            self.assertEqual(new_value, exp_value)
+
+    def test_meta_annotations_renamed_values(self):
+        prev_anns = list(self._get_all_meta_anns())
+        self.export.rename_meta_anns(
+            meta_anns2rename=self.VALUES_RENAME_HELPER,
+            meta_ann_values2rename=self.VALUES2RENAME)
+        self._check_values(prev_anns)
+
+    def test_meta_annotations_renamed_names_and_values(self):
+        prev_anns = list(self._get_all_meta_anns())
+        self.export.rename_meta_anns(
+            meta_anns2rename=self.NAMES2RENAME,
+            meta_ann_values2rename=self.VALUES2RENAME)
+        self._check_names(prev_anns)
+        self._check_values(prev_anns, only_values=False)
+
+    def test_meta_annotations_renamed_values_only(self):
+        prev_anns = list(self._get_all_meta_anns())
+        self.export.rename_meta_anns(meta_ann_values2rename=self.VALUES2RENAME)
+        self._check_values(prev_anns, only_values=True)
diff --git a/medcat-scripts/tests/resources/MCT_export_example.json b/medcat-scripts/tests/resources/MCT_export_example.json
new file mode 100644
index 00000000..159ba44c
--- /dev/null
+++ b/medcat-scripts/tests/resources/MCT_export_example.json
@@ -0,0 +1 @@
+{"projects": [{"name": "MartTestAnnotation", "id": 1, "cuis": "", "documents": [{"id": 1, "name": "Doc 1", "text": "Bronchogenic carcinoma with chest wall invasion. Bronchogenic carcinoma with chest wall involvement continues to present a major clinical challenge. We have treated 52 patients since 1973, excluding those with superior sulcus tumors. There were 37 male and 15 female patients with an average age of 62.9 years. Chest pain was an initial symptom in 37%. All patients had negative mediastinoscopy results. Squamous cell carcinoma was present in 53% and adenocarcinoma in 35%. The median number of ribs resected was two (range, one to six), and only 2 patients required chest wall reconstruction. Pathologic staging was T3 N0 M0 in 83% and T3 N1 M0 in 17%. Operative mortality was 3.8%. Absolute 5-year survival was 26.3%. Patients who had N1 disease had a 5-year survival of only 11%. Radiation therapy was employed in 46% for positive nodes or close margins. Bronchogenic carcinoma with chest wall invasion remains potentially curable if N2 nodes are not involved. The role of radiation therapy has not been clearly defined. Morbidity and mortality should be minimal.", "last_modified": "2023-02-07:14:56:12", "annotations": [{"id": 1, "user": "mart", "cui": "120153004", "value": "chest wall reconstruction", "start": 567, "end": 592, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-07:15:34:38", "last_modified": "2023-02-07:15:44:20", "comment": null, "manually_created": false, "meta_anns": {"Status": {"value": "Affirmed", "confidence": 0.9993376731872559, "name": "Status"}}}, {"id": 2, "user": "mart", "cui": "402815007", "value": "Squamous cell carcinoma", "start": 404, "end": 427, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-07:15:34:38", "last_modified": "2023-02-07:15:43:56", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 3, "user": "mart", "cui": "363493006", "value": "Bronchogenic carcinoma", "start": 0, "end": 22, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-07:15:34:38", "last_modified": "2023-02-07:15:36:00", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 4, "user": "mart", "cui": "363493006", "value": "Bronchogenic carcinoma", "start": 49, "end": 71, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-07:15:34:38", "last_modified": "2023-02-07:15:43:23", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 5, "user": "mart", "cui": "254638002", "value": "superior sulcus tumors", "start": 210, "end": 232, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-07:15:34:38", "last_modified": "2023-02-07:15:43:37", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 6, 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"create_time": "2023-02-07:15:34:39", "last_modified": "2023-02-07:15:43:43", "comment": null, "manually_created": false, "meta_anns": {}}], "relations": []}, {"id": 2, "name": "Doc 2", "text": "Electronic weaponry--a question of safety [published erratum appears in Ann Emerg Med 1991 Sep;20(9):1031] Electronic weapons represent a new class of weapon available to law enforcement and the lay public. Although these weapons have been available for several years, there is inadequate research to document their safety or efficacy. Two of the most common, the TASER and the stun gun, are reviewed. The electronic weapon was initially and still is approved by the US Consumer Product Safety Commission; its approval was based on theoretical calculations of the physical effects of damped sinusoidal pulses, not on the basis of animal or human studies. These devices are widely available and heavily promoted, despite limited research into their safety or efficiency and despite recent animal studies documenting their potential for lethality.", "last_modified": "2023-02-07:14:56:12", "annotations": [{"id": 135, "user": "mart", "cui": "773830008", "value": "Consumer Product", "start": 470, "end": 486, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:16:16", "last_modified": "2023-02-13:11:17:42", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 136, "user": "mart", "cui": "702873001", "value": "calculations", "start": 544, "end": 556, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:16:16", "last_modified": "2023-02-13:11:17:42", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 137, "user": "mart", "cui": 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"correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:16:16", "last_modified": "2023-02-13:11:17:41", "comment": null, "manually_created": false, "meta_anns": {}}], "relations": []}, {"id": 3, "name": "Doc 3", "text": "Operative management of acoustic neuromas: the priority of neurologic function over complete resection. The objective of surgical management of acoustic tumors is to remove them entirely and preserve facial nerve function and hearing when possible. A dilemma arises when it is not possible to remove the entire tumor without incurring additional neurologic deficits. Twenty patients who underwent intentional incomplete surgical removal of an acoustic neuroma to avoid further neurologic deficit were retrospectively reviewed. They were divided into a subtotal group (resection of less than 95% of tumor) and a near-total group (resection of 95% or more of tumor) and were followed yearly with either computed tomography or magnetic resonance imaging. The subtotal group was planned and consisted of elderly patients (mean age, 68.5 years) with large tumors (mean, 3.1 cm). The near-total group consisted of younger patients (mean age, 45.8 years) and smaller tumors (mean, 2.3 cm). The mean length of followup for all patients was 5.0 years. Ninety percent of patients had House grade I or II facial function post-operatively. Radiologically detectable tumor regrowth occurred in only one patient, who was in the subtotal resection group. Near-total resection of acoustic tumor was not associated with radiologic evidence of regrowth of tumor for the period of observation. Within the limits of the follow-up period of this study, subtotal resection of acoustic neuroma in elderly patients was not associated with clinically significant recurrence in most patients and produced highly satisfactory rates of facial preservation with low surgical morbidity.", "last_modified": "2023-02-07:14:56:12", "annotations": [{"id": 175, "user": "mart", "cui": "113091000", "value": "magnetic resonance imaging", "start": 724, "end": 750, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:17:52", "last_modified": "2023-02-13:11:18:04", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 176, "user": "mart", "cui": "112106009", "value": "facial nerve function", "start": 200, "end": 221, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:17:52", "last_modified": 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Torsades de pointes is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although found in many clinical settings, torsades de pointes is most often drug induced. This report describes the first association (exclusive of drug overdose) of symptomatic torsades de pointes occurring with the use of terfenadine in a patient who was taking the recommended prescribed dose of this drug in addition to cefaclor, ketoconazole, and medroxyprogesterone. Measured serum concentrations of terfenadine and its main metabolite showed excessive levels of parent terfenadine and proportionately reduced concentrations of metabolite, suggesting inhibition of terfenadine metabolism. We believe that a drug interaction between terfenadine and ketoconazole resulted in the elevated terfenadine levels in plasma and in the cardiotoxicity previously seen only in cases of terfenadine overdose.", "last_modified": "2023-02-07:14:56:12", "annotations": [{"id": 281, "user": "mart", "cui": "251159007", "value": "polymorphic ventricular tachycardia", "start": 100, "end": 135, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:26", "last_modified": "2023-02-13:11:18:30", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 282, "user": "mart", "cui": "31722008", "value": "Torsades de pointes", "start": 0, "end": 19, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:26", "last_modified": "2023-02-13:11:18:30", "comment": null, "manually_created": false, "meta_anns": {}}, 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"manually_created": false, "meta_anns": {}}, {"id": 337, "user": "mart", "cui": "63161005", "value": "main", "start": 619, "end": 623, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:27", "last_modified": "2023-02-13:11:18:32", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 338, "user": "mart", "cui": "277889008", "value": "use", "start": 62, "end": 65, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:27", "last_modified": "2023-02-13:11:18:30", "comment": null, "manually_created": false, "meta_anns": {}}], "relations": []}, {"id": 5, "name": "Doc 5", "text": "Asymptomatic celiac and superior mesenteric artery stenoses are more prevalent among patients with unsuspected renal artery stenoses. The prevalence of unsuspected renal artery stenosis among patients with peripheral vascular disease has been reported to be as high as 40%, but the prevalence of asymptomatic celiac and superior mesenteric artery stenoses in these patients is not known. The biplane aortograms of 205 male patients who were military veterans and had aneurysms or occlusive disease were independently reviewed, and medical records were studied to determine associated coronary disease, risk factors, and patient outcome. Fifty-six patients (27%) had a 50% or greater stenosis in the celiac or superior mesenteric artery, and seven patients (3.4%) had significant stenoses in both mesenteric arteries. Patients with celiac or superior mesenteric artery stenoses were older (p = 0.002) and had a higher prevalence of hypertension (p = 0.029) than those without significant mesenteric stenoses. Fifty of the 205 patients had significant renal artery stenoses, and 20 had advanced (greater than 75% diameter loss) renal stenoses. Ten of the 20 patients (50%) with advanced renal stenoses had a concomitant celiac artery stenosis, compared to 40 of the 185 patients (22%) who did not have advanced renal stenoses (p = 0.011). In the present study asymptomatic celiac or superior mesenteric artery stenoses were common among male veterans evaluated for peripheral vascular disease, but the prevalence of significant stenoses in both the celiac and superior mesenteric arteries was low. The prevalence of significant celiac stenosis was higher in patients with advanced (greater than 75%) renal artery stenoses who might be considered for prophylactic renal revascularization. Lateral aortography with evaluation of the celiac artery is always appropriate in these patients.", "last_modified": "2023-02-07:14:56:12", "annotations": [{"id": 339, "user": "mart", "cui": "42258001", "value": "superior mesenteric arteries", "start": 1558, "end": 1586, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:45", "last_modified": "2023-02-13:11:19:05", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 340, "user": "mart", "cui": "400047006", "value": "peripheral vascular disease", "start": 206, "end": 233, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:45", "last_modified": "2023-02-13:11:18:51", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 341, "user": "mart", "cui": "400047006", "value": "peripheral vascular disease", "start": 1463, 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false, "meta_anns": {}}, {"id": 406, "user": "mart", "cui": "415582006", "value": "stenoses", "start": 1191, "end": 1199, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:04", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 407, "user": "mart", "cui": "116154003", "value": "patients", "start": 1268, "end": 1276, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:04", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 408, "user": "mart", "cui": "86005002", "value": "advanced", "start": 1300, "end": 1308, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:04", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 409, "user": "mart", "cui": "415582006", "value": "stenoses", "start": 1315, "end": 1323, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:04", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 410, "user": "mart", "cui": "415582006", "value": "stenoses", "start": 1408, "end": 1416, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:05", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 411, "user": "mart", "cui": "415582006", "value": "stenoses", "start": 1526, "end": 1534, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:05", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 412, "user": "mart", "cui": "415582006", "value": "stenosis", "start": 1633, "end": 1641, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:05", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 413, "user": "mart", "cui": "116154003", "value": "patients", "start": 1656, "end": 1664, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:06", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 414, "user": "mart", "cui": "86005002", "value": "advanced", "start": 1670, "end": 1678, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:06", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 415, "user": "mart", "cui": "116154003", "value": "patients", "start": 1874, "end": 1882, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:06", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 416, "user": "mart", "cui": "64572001", "value": "disease", "start": 490, "end": 497, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:52", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 417, "user": "mart", "cui": "224699009", "value": "studied", "start": 552, "end": 559, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:53", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 418, "user": "mart", "cui": "116154003", "value": "patient", "start": 620, "end": 627, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:53", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 419, "user": "mart", "cui": "717661000000106", "value": "outcome", "start": 628, "end": 635, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:53", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 420, "user": "mart", "cui": 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"meta_anns": {}}, {"id": 423, "user": "mart", "cui": "396331005", "value": "celiac", "start": 13, "end": 19, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:51", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 424, "user": "mart", "cui": "396331005", "value": "celiac", "start": 309, "end": 315, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:52", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 425, "user": "mart", "cui": "396331005", "value": "celiac", "start": 699, "end": 705, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:53", 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"value": "male", "start": 418, "end": 422, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:18:52", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 441, "user": "mart", "cui": "10052007", "value": "male", "start": 1435, "end": 1439, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:05", "comment": null, "manually_created": false, "meta_anns": {}}, {"id": 442, "user": "mart", "cui": "62482003", "value": "low", "start": 1591, "end": 1594, "validated": true, "correct": true, "deleted": false, "alternative": false, "killed": false, "irrelevant": false, "create_time": "2023-02-13:11:18:46", "last_modified": "2023-02-13:11:19:05", "comment": null, "manually_created": false, "meta_anns": {}}], "relations": []}]}]}
\ No newline at end of file
diff --git a/medcat-scripts/tests/resources/example_model_pack.zip b/medcat-scripts/tests/resources/example_model_pack.zip
new file mode 100644
index 00000000..b6bc74e4
Binary files /dev/null and b/medcat-scripts/tests/resources/example_model_pack.zip differ
diff --git a/medcat-scripts/tests/setup_for_tests.py b/medcat-scripts/tests/setup_for_tests.py
new file mode 100644
index 00000000..4f0fb4a7
--- /dev/null
+++ b/medcat-scripts/tests/setup_for_tests.py
@@ -0,0 +1,20 @@
+import os
+
+from medcat.cat import CAT
+
+from medcat_den.den import get_default_den
+
+EXAMPLE_MODEL_PATH = os.path.join(
+    os.path.dirname(__file__), "resources", "example_model_pack.zip")
+
+
+def main():
+    den = get_default_den()
+    model = CAT.load_model_pack(EXAMPLE_MODEL_PATH)
+    model.config.meta.ontology = ["FAKE ONTO"]
+    print("Pushing model to den:", model.config.meta.hash)
+    den.push_model(model, "Base FAKE model")
+
+
+if __name__ == "__main__":
+    main()