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            [0] => a:17:{i:0;a:3:{s:8:"question";s:15:"Chief Complaint";s:6:"answer";s:8:"Rib Pain";s:13:"preload_value";s:0:"";}i:1;a:3:{s:8:"question";s:26:"History of Present Illness";s:6:"answer";s:1025:"The patient is a 20-year-old female with a history of heart disease who presents to the emergency department with a chief complaint of right sided rib pain.  Symptoms began at 10:30 AM today after a four wheeler accident. The patient was driving a four wheeler when it accidentally shifted into neutral and she hit her ribcage on the handlebars, fell off the four wheeler, and the four wheeler landed on her. The four wheeler had to be lifted off of her. Rib pain is currently rated as a 10/10 in severity and described as achy with radiation to the abdomen. Associated symptoms include a headache, neck pain, and nausea. Symptoms are aggravated with movement, going over bumps in the car, and deep inspiration. There are no alleviating factors. She reports that she was drinking alcohol prior to the accident. The patient denies head trauma, loss of consciousness, blurred vision, diplopia, chest pain, shortness of breath, emesis, trauma to other extremities, 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:38:"Heart Disease
MI
Atrial Fibrillation";s:13:"preload_value";s:0:"";}i:4;a:3:{s:8:"question";s:19:"Current Medications";s:6:"answer";s:8:"Coumadin";s:13:"preload_value";s:0:"";}i:5;a:3:{s:8:"question";s:9:"Allergies";s:6:"answer";s:29:"Penicillin, Vicodin, Benadryl";s:13:"preload_value";s:0:"";}i:6;a:3:{s:8:"question";s:14:"Social History";s:6:"answer";s:127:"Smoking Status - Not Asked
Smokeless Tobacco - Not Asked
Alcohol Use - Yes
Drug Use - Not Asked
Sexual Activity - Not Asked";s:13:"preload_value";s:0:"";}i:7;a:3:{s:8:"question";s:14:"Family History";s:6:"answer";s:53:"Heart Disease - Mom, Dad, Aunts, Uncles, Grandparents";s:13:"preload_value";s:0:"";}i:8;a:3:{s:8:"question";s:19:"Initial Vital Signs";s:6:"answer";s:3:"N/A";s:13:"preload_value";s:3:"N/A";}i:9;a:3:{s:8:"question";s:13:"Physical Exam";s:6:"answer";s:2293:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm 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. Rods in place to the outer ears bilaterally.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is cervical paraspinal tenderness and spasm. There is no midline 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. There is crepitus and tenderness to palpation over the lateral aspect of the right ribs 9-11. 
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: Regularly irregular 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:2092:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm 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. Rods in place to the outer ears bilaterally.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is cervical paraspinal tenderness and spasm. There is no midline 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: Regularly irregular 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:25:"EKG
X Ribs Right 2 Views";s:13:"preload_value";s:0:"";}i:11;a:3:{s:8:"question";s:9:"Radiology";s:6:"answer";s:199:"X Ribs Right 2 Views: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right Rib Pain
Interpretation: Nondisplaced fractures of ribs 9 and 10. Soft tissue swelling noted";s:13:"preload_value";s:0:"";}i:12;a:3:{s:8:"question";s:10:"Procedures";s:6:"answer";s:258:"An EKG was obtained and interpreted by Dr. ***. 
Indication: Rib Pain
Interpretation: Per my interpretation, this showed atrial fibrillation. There is a noted ventricular rate of 72 bpm, PR interval of 144 ms, QRS duration of 120 ms, QTc interval of 429ms.";s:13:"preload_value";s:0:"";}i:13;a:3:{s:8:"question";s:23:"Calls/Consults/Rechecks";s:6:"answer";s:230:"***: Rechecked patient who is resting comfortably. Imaging results were discussed. The plan for discharge was discussed. The patient is requesting a work excuse at this time. Patient agrees with plan. All questions were addressed.";s:13:"preload_value";s:0:"";}i:14;a:3:{s:8:"question";s:23:"Medical Decision Making";s:6:"answer";s:869:"The patient is a female who presents to the emergency department with a chief complaint of right sided rib pain.  Medical records were reviewed. A right rib x-ray was ordered and reviewed. Imaging shows nondisplaced fractures of ribs 9 and 10, as well as soft tissue swelling.  An EKG was taken and showed atrial fibrillation. The patient was discharged home with a diagnosis of rib fracture. It was recommended for the patient to follow up with Dr. Wallis (Orthopedics) as soon as possible. It was also recommended to obtain a stress test and following up with Dr. Miller (PCP). The patient was provided prescriptions for Percocet. She was also provided a work excuse. 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:15;a:3:{s:8:"question";s:16:"Final Impression";s:6:"answer";s:12:"Rib Fracture";s:13:"preload_value";s:0:"";}i:16;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 #15 REVIEW: RIB PAIN - AGE 20
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Array
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    [0] => Array
        (
            [question] => Chief Complaint
            [answer] => Rib Pain
            [preload_value] => 
        )

    [1] => Array
        (
            [question] => History of Present Illness
            [answer] => The patient is a 20-year-old female with a history of heart disease who presents to the emergency department with a chief complaint of right sided rib pain.  Symptoms began at 10:30 AM today after a four wheeler accident. The patient was driving a four wheeler when it accidentally shifted into neutral and she hit her ribcage on the handlebars, fell off the four wheeler, and the four wheeler landed on her. The four wheeler had to be lifted off of her. Rib pain is currently rated as a 10/10 in severity and described as achy with radiation to the abdomen. Associated symptoms include a headache, neck pain, and nausea. Symptoms are aggravated with movement, going over bumps in the car, and deep inspiration. There are no alleviating factors. She reports that she was drinking alcohol prior to the accident. The patient denies head trauma, loss of consciousness, blurred vision, diplopia, chest pain, shortness of breath, emesis, trauma to other extremities, 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] => Heart Disease
MI
Atrial Fibrillation
            [preload_value] => 
        )

    [4] => Array
        (
            [question] => Current Medications
            [answer] => Coumadin
            [preload_value] => 
        )

    [5] => Array
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            [question] => Allergies
            [answer] => Penicillin, Vicodin, Benadryl
            [preload_value] => 
        )

    [6] => Array
        (
            [question] => Social History
            [answer] => Smoking Status - Not Asked
Smokeless Tobacco - Not Asked
Alcohol Use - Yes
Drug Use - Not Asked
Sexual Activity - Not Asked
            [preload_value] => 
        )

    [7] => Array
        (
            [question] => Family History
            [answer] => Heart Disease - Mom, Dad, Aunts, Uncles, Grandparents
            [preload_value] => 
        )

    [8] => Array
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            [question] => Initial Vital Signs
            [answer] => N/A
            [preload_value] => N/A
        )

    [9] => Array
        (
            [question] => Physical Exam
            [answer] => GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm 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. Rods in place to the outer ears bilaterally.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is cervical paraspinal tenderness and spasm. There is no midline 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. There is crepitus and tenderness to palpation over the lateral aspect of the right ribs 9-11. 
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: Regularly irregular 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 3mm 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. Rods in place to the outer ears bilaterally.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is cervical paraspinal tenderness and spasm. There is no midline 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: Regularly irregular 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] => EKG
X Ribs Right 2 Views
            [preload_value] => 
        )

    [11] => Array
        (
            [question] => Radiology
            [answer] => X Ribs Right 2 Views: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right Rib Pain
Interpretation: Nondisplaced fractures of ribs 9 and 10. Soft tissue swelling noted
            [preload_value] => 
        )

    [12] => Array
        (
            [question] => Procedures
            [answer] => An EKG was obtained and interpreted by Dr. ***. 
Indication: Rib Pain
Interpretation: Per my interpretation, this showed atrial fibrillation. There is a noted ventricular rate of 72 bpm, PR interval of 144 ms, QRS duration of 120 ms, QTc interval of 429ms.
            [preload_value] => 
        )

    [13] => Array
        (
            [question] => Calls/Consults/Rechecks
            [answer] => ***: Rechecked patient who is resting comfortably. Imaging results were discussed. The plan for discharge was discussed. The patient is requesting a work excuse at this time. Patient agrees with plan. All questions were addressed.
            [preload_value] => 
        )

    [14] => Array
        (
            [question] => Medical Decision Making
            [answer] => The patient is a female who presents to the emergency department with a chief complaint of right sided rib pain.  Medical records were reviewed. A right rib x-ray was ordered and reviewed. Imaging shows nondisplaced fractures of ribs 9 and 10, as well as soft tissue swelling.  An EKG was taken and showed atrial fibrillation. The patient was discharged home with a diagnosis of rib fracture. It was recommended for the patient to follow up with Dr. Wallis (Orthopedics) as soon as possible. It was also recommended to obtain a stress test and following up with Dr. Miller (PCP). The patient was provided prescriptions for Percocet. She was also provided a work excuse. 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.
        )

    [15] => Array
        (
            [question] => Final Impression
            [answer] => Rib Fracture
            [preload_value] => 
        )

    [16] => 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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