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            [0] => a:18:{i:0;a:3:{s:8:"question";s:15:"Chief Complaint";s:6:"answer";s:10:"Flank Pain";s:13:"preload_value";s:0:"";}i:1;a:3:{s:8:"question";s:26:"History of Present Illness";s:6:"answer";s:788:"The patient is a 21-year-old female with a history of kidney stones who presents to the emergency department with a chief complaint of right sided flank pain.  Symptoms began suddenly today when the patient bent over at work to pick up french fries off the floor and have been constant since onset. Pain is currently rated as a 10/10 in severity and described as “pain she has never felt before” with no radiation. Associated symptoms include nausea, emesis, diaphoresis, urinary urgency, and urinary retention.  Symptoms are aggravated with movement and there are no alleviating factors. The patient denies chest pain, shortness of breath, back pain, abdominal pain, hematuria, diarrhea, hematochezia, melanotic stool, or any other symptoms.  No other reported symptoms at this time.";s:13:"preload_value";s:486:"The patient is a [age] [sex] who presents to the emergency department with a chief complaint of ***. The symptoms began *** and have been *** since onset. His/her*** pain is currently rated as a ***/10 in severity and described as *** with radiation to ***. Associated symptoms include ***. Symptoms are aggravated with *** and improve with ***. The patient denies ***.  He/she*** reports taking *** prior to arrival with *** relief of symptoms. No other reported symptoms at this time.";}i:2;a:3:{s:8:"question";s:17:"Review of Systems";s:6:"answer";s:89:"All pertinent positive findings are listed in the HPI and all other systems are negative.";s:13:"preload_value";s:0:"";}i:3;a:3:{s:8:"question";s:20:"Past Medical History";s:6:"answer";s:13:"Kidney stones";s:13:"preload_value";s:0:"";}i:4;a:3:{s:8:"question";s:19:"Current Medications";s:6:"answer";s:22:"No current medications";s:13:"preload_value";s:0:"";}i:5;a:3:{s:8:"question";s:9:"Allergies";s:6:"answer";s:8:"Morphine";s:13:"preload_value";s:0:"";}i:6;a:3:{s:8:"question";s:14:"Social History";s:6:"answer";s:109:"Smoking Status - Never Smoker
Smokeless Tobacco - No
Alcohol Use - No
Drug Use - No
Sexual Activity - N/A";s:13:"preload_value";s:0:"";}i:7;a:3:{s:8:"question";s:14:"Family History";s:6:"answer";s:70:"Denies family history of cancer, diabetes, heart disease, and seizures";s:13:"preload_value";s:0:"";}i:8;a:3:{s:8:"question";s:19:"Initial Vital Signs";s:6:"answer";s:4:"None";s:13:"preload_value";s:4:"None";}i:9;a:3:{s:8:"question";s:13:"Physical Exam";s:6:"answer";s:2104:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 2mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: There is no midline or paraspinal tenderness to palpation, no evidence of trauma, there is no CVA tenderness.
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: The patient is alert and oriented x3. No cranial nerve deficit. Motor examination reveals +5/5 strength throughout. Sensation is normal throughout. Finger-to-nose intact. Heel-to-shin intact. Negative Romberg sign. Gait and station appear normal. Visual fields are full to confrontation.
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.";s:13:"preload_value";s:1998:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 2mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: ***
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: The patient is alert and oriented x3. No cranial nerve deficit. Motor examination reveals +5/5 strength throughout. Sensation is normal throughout. Finger-to-nose intact. Heel-to-shin intact. Negative Romberg sign. Gait and station appear normal. Visual fields are full to confrontation.
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.";}i:10;a:3:{s:8:"question";s:18:"ED COURSE:
Orders";s:6:"answer";s:10:"CT Abdomen";s:13:"preload_value";s:0:"";}i:11;a:3:{s:8:"question";s:24:"Medications Administered";s:6:"answer";s:49:"0.9% Normal Saline
Pain Medication (unspecified)";s:13:"preload_value";s:0:"";}i:12;a:3:{s:8:"question";s:9:"Radiology";s:6:"answer";s:139:"CT Abdomen: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right flank pain
Interpretation: Nephrolithiasis";s:13:"preload_value";s:0:"";}i:13;a:3:{s:8:"question";s:10:"Procedures";s:6:"answer";s:4:"None";s:13:"preload_value";s:4:"None";}i:14;a:3:{s:8:"question";s:23:"Calls/Consults/Rechecks";s:6:"answer";s:210:"***: Rechecked patient who is resting comfortably. Her pain has improved to a 7/10.  Imaging results were discussed. The plan for discharge was discussed. Patient agrees with plan. All questions were addressed.";s:13:"preload_value";s:0:"";}i:15;a:3:{s:8:"question";s:23:"Medical Decision Making";s:6:"answer";s:819:"The patient is a female who presents to the emergency department with a chief complaint of right sided flank pain.  Medical records were reviewed. An abdominal CT was ordered and reviewed. Imaging shows nephrolithiasis. The patient was provided with pain medication (unspecified) and 0.9% normal saline resulting in slight improvement of symptoms.  The patient was discharged home with a diagnosis of nephrolithiasis.  It was recommended for the patient to follow up with her PCP for a recheck in 3 days or the ED if symptoms change or worsen.  The patient was provided prescriptions for pain medication (unspecified).  The patient's vital signs and condition remained stable while undergoing evaluation in the Emergency Department. The patient agreed with the plan for care.  All questions and concerns were addressed.";s:13:"preload_value";s:676:"The patient is a @AGE@ @SEX@ who presents to the emergency department with a chief complaint of ***.  Medical records were reviewed. Multiple diagnoses were considered.  Lab work was ordered and reviewed. A *** was also ordered and reviewed. Imaging shows ***.  The patient was provided with *** resulting in *** of symptoms. The patient was diagnosed with ***. The patient was advised to ***. It was recommended for the patient to follow up with ***.  The patient was prescribed ***.  The patient's vital signs and condition *** while undergoing evaluation in the Emergency Department. The patient*** agreed with the plan for care.  All questions and concerns were addressed.";}i:16;a:3:{s:8:"question";s:16:"Final Impression";s:6:"answer";s:15:"Nephrolithiasis";s:13:"preload_value";s:0:"";}i:17;a:3:{s:8:"question";s:4:"Plan";s:6:"answer";s:103:"The patient is discharged home in stable condition and does not have any further questions or concerns.";s:13:"preload_value";s:0:"";}}
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            [0] => Mock Patient #12: FLANK PAIN - AGE 21
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            [0] => Mock Patient #12 REVIEW: FLANK PAIN - AGE 21
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Array
(
    [0] => Array
        (
            [question] => Chief Complaint
            [answer] => Flank Pain
            [preload_value] => 
        )

    [1] => Array
        (
            [question] => History of Present Illness
            [answer] => The patient is a 21-year-old female with a history of kidney stones who presents to the emergency department with a chief complaint of right sided flank pain.  Symptoms began suddenly today when the patient bent over at work to pick up french fries off the floor and have been constant since onset. Pain is currently rated as a 10/10 in severity and described as “pain she has never felt before” with no radiation. Associated symptoms include nausea, emesis, diaphoresis, urinary urgency, and urinary retention.  Symptoms are aggravated with movement and there are no alleviating factors. The patient denies chest pain, shortness of breath, back pain, abdominal pain, hematuria, diarrhea, hematochezia, melanotic stool, or any other symptoms.  No other reported symptoms at this time.
            [preload_value] => The patient is a [age] [sex] who presents to the emergency department with a chief complaint of ***. The symptoms began *** and have been *** since onset. His/her*** pain is currently rated as a ***/10 in severity and described as *** with radiation to ***. Associated symptoms include ***. Symptoms are aggravated with *** and improve with ***. The patient denies ***.  He/she*** reports taking *** prior to arrival with *** relief of symptoms. No other reported symptoms at this time.
        )

    [2] => Array
        (
            [question] => Review of Systems
            [answer] => All pertinent positive findings are listed in the HPI and all other systems are negative.
            [preload_value] => 
        )

    [3] => Array
        (
            [question] => Past Medical History
            [answer] => Kidney stones
            [preload_value] => 
        )

    [4] => Array
        (
            [question] => Current Medications
            [answer] => No current medications
            [preload_value] => 
        )

    [5] => Array
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            [question] => Allergies
            [answer] => Morphine
            [preload_value] => 
        )

    [6] => Array
        (
            [question] => Social History
            [answer] => Smoking Status - Never Smoker
Smokeless Tobacco - No
Alcohol Use - No
Drug Use - No
Sexual Activity - N/A
            [preload_value] => 
        )

    [7] => Array
        (
            [question] => Family History
            [answer] => Denies family history of cancer, diabetes, heart disease, and seizures
            [preload_value] => 
        )

    [8] => Array
        (
            [question] => Initial Vital Signs
            [answer] => None
            [preload_value] => None
        )

    [9] => Array
        (
            [question] => Physical Exam
            [answer] => GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 2mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: There is no midline or paraspinal tenderness to palpation, no evidence of trauma, there is no CVA tenderness.
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: The patient is alert and oriented x3. No cranial nerve deficit. Motor examination reveals +5/5 strength throughout. Sensation is normal throughout. Finger-to-nose intact. Heel-to-shin intact. Negative Romberg sign. Gait and station appear normal. Visual fields are full to confrontation.
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.
            [preload_value] => GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 2mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: ***
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: The patient is alert and oriented x3. No cranial nerve deficit. Motor examination reveals +5/5 strength throughout. Sensation is normal throughout. Finger-to-nose intact. Heel-to-shin intact. Negative Romberg sign. Gait and station appear normal. Visual fields are full to confrontation.
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.
        )

    [10] => Array
        (
            [question] => ED COURSE:
Orders
            [answer] => CT Abdomen
            [preload_value] => 
        )

    [11] => Array
        (
            [question] => Medications Administered
            [answer] => 0.9% Normal Saline
Pain Medication (unspecified)
            [preload_value] => 
        )

    [12] => Array
        (
            [question] => Radiology
            [answer] => CT Abdomen: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right flank pain
Interpretation: Nephrolithiasis
            [preload_value] => 
        )

    [13] => Array
        (
            [question] => Procedures
            [answer] => None
            [preload_value] => None
        )

    [14] => Array
        (
            [question] => Calls/Consults/Rechecks
            [answer] => ***: Rechecked patient who is resting comfortably. Her pain has improved to a 7/10.  Imaging results were discussed. The plan for discharge was discussed. Patient agrees with plan. All questions were addressed.
            [preload_value] => 
        )

    [15] => Array
        (
            [question] => Medical Decision Making
            [answer] => The patient is a female who presents to the emergency department with a chief complaint of right sided flank pain.  Medical records were reviewed. An abdominal CT was ordered and reviewed. Imaging shows nephrolithiasis. The patient was provided with pain medication (unspecified) and 0.9% normal saline resulting in slight improvement of symptoms.  The patient was discharged home with a diagnosis of nephrolithiasis.  It was recommended for the patient to follow up with her PCP for a recheck in 3 days or the ED if symptoms change or worsen.  The patient was provided prescriptions for pain medication (unspecified).  The patient's vital signs and condition remained stable while undergoing evaluation in the Emergency Department. The patient agreed with the plan for care.  All questions and concerns were addressed.
            [preload_value] => The patient is a @AGE@ @SEX@ who presents to the emergency department with a chief complaint of ***.  Medical records were reviewed. Multiple diagnoses were considered.  Lab work was ordered and reviewed. A *** was also ordered and reviewed. Imaging shows ***.  The patient was provided with *** resulting in *** of symptoms. The patient was diagnosed with ***. The patient was advised to ***. It was recommended for the patient to follow up with ***.  The patient was prescribed ***.  The patient's vital signs and condition *** while undergoing evaluation in the Emergency Department. The patient*** agreed with the plan for care.  All questions and concerns were addressed.
        )

    [16] => Array
        (
            [question] => Final Impression
            [answer] => Nephrolithiasis
            [preload_value] => 
        )

    [17] => Array
        (
            [question] => Plan
            [answer] => The patient is discharged home in stable condition and does not have any further questions or concerns.
            [preload_value] => 
        )

)

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