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            [0] => a:18:{i:0;a:3:{s:8:"question";s:15:"Chief Complaint";s:6:"answer";s:15:"Shoulder Injury";s:13:"preload_value";s:0:"";}i:1;a:3:{s:8:"question";s:26:"History of Present Illness";s:6:"answer";s:783:"The patient is a 27-year-old male with no significant past medical history who presents to the emergency department with a chief complaint of a right shoulder injury. Symptoms began at 7:00 PM last night when the patient was playing basketball, was shoved into a wall, and hit his right shoulder. Associated symptoms include right shoulder pain and decreased movement of the right shoulder. Pain is currently rated as a 8/10 in severity and described as achy with no radiation. Symptoms are aggravated with movement and there are no alleviating factors. The patient denies open wounds, paresthesias, trauma to other extremities, or any other symptoms.  He reports taking Tylenol and ibuprofen prior to arrival with minimal relief of 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:18:"Previously Healthy";s:13:"preload_value";s:0:"";}i:4;a:3:{s:8:"question";s:19:"Current Medications";s:6:"answer";s:4:"None";s:13:"preload_value";s:0:"";}i:5;a:3:{s:8:"question";s:9:"Allergies";s:6:"answer";s:23:"No known drug allergies";s:13:"preload_value";s:0:"";}i:6;a:3:{s:8:"question";s:14:"Social History";s:6:"answer";s:133:"Smoking Status  -Not asked
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Alcohol Use - Not asked
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:48:"Myocardial Infarction - Uncle
Diabetes - Sister";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:2138:"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.
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: Tenderness to the right shoulder. The right shoulder appears to be dislocated. 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:1907:"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.
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: ***
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:21:"X Shoulder Rt 3 Views";s:13:"preload_value";s:0:"";}i:11;a:3:{s:8:"question";s:24:"Medications Administered";s:6:"answer";s:8:"Dilaudid";s:13:"preload_value";s:0:"";}i:12;a:3:{s:8:"question";s:9:"Radiology";s:6:"answer";s:352:"X Shoulder Rt 3 Views: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right shoulder injury
Interpretation: Dislocated Right Shoulder

X Shoulder Rt 3 Views: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right shoulder relocation
Interpretation: Proper relocation of the right shoulder";s:13:"preload_value";s:0:"";}i:13;a:3:{s:8:"question";s:10:"Procedures";s:6:"answer";s:396:"Joint Reduction
The patient was made aware of the risks of a joint reduction including nerve damage and fracture. A right shoulder joint reduction was performed by Dr. ***. The reduction was successful on the first attempt. Capillary refill and radial pulses are unchanged after the procedure. The patient was able to move the right shoulder after the reduction and tolerated the procedure well.";s:13:"preload_value";s:0:"";}i:14;a:3:{s:8:"question";s:23:"Calls/Consults/Rechecks";s:6:"answer";s:177:"***: Rechecked patient who is resting comfortably. 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:962:"The patient is a male who presents to the emergency department with a chief complaint of a right shoulder injury.  Medical records were reviewed. A right shoulder x-ray was ordered and reviewed. Imaging shows a dislocated right shoulder. A joint reduction was performed by Dr. *** and was successful on the first attempt. A right shoulder x-ray confirmed the proper relocation of the right shoulder. The patient was provided with Dilaudid resulting in improvement of symptoms.  The patient was discharged home with a diagnosis of right shoulder dislocation. The patient was advised to rest and ice the right shoulder. It was recommended for the patient to follow up with Dr. Carter (PCP) as soon as possible.  The patient was provided prescriptions for Vicodin.  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:26:"Right Shoulder Dislocation";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 #23: SHOULDER INJURY - AGE 27
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            [0] => Mock Patient #23 REVIEW: SHOULDER INJURY - AGE 27
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Array
(
    [0] => Array
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            [question] => Chief Complaint
            [answer] => Shoulder Injury
            [preload_value] => 
        )

    [1] => Array
        (
            [question] => History of Present Illness
            [answer] => The patient is a 27-year-old male with no significant past medical history who presents to the emergency department with a chief complaint of a right shoulder injury. Symptoms began at 7:00 PM last night when the patient was playing basketball, was shoved into a wall, and hit his right shoulder. Associated symptoms include right shoulder pain and decreased movement of the right shoulder. Pain is currently rated as a 8/10 in severity and described as achy with no radiation. Symptoms are aggravated with movement and there are no alleviating factors. The patient denies open wounds, paresthesias, trauma to other extremities, or any other symptoms.  He reports taking Tylenol and ibuprofen prior to arrival with minimal relief of 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
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            [question] => Past Medical History
            [answer] => Previously Healthy
            [preload_value] => 
        )

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            [question] => Current Medications
            [answer] => None
            [preload_value] => 
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            [question] => Allergies
            [answer] => No known drug allergies
            [preload_value] => 
        )

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

    [7] => Array
        (
            [question] => Family History
            [answer] => Myocardial Infarction - Uncle
Diabetes - Sister
            [preload_value] => 
        )

    [8] => Array
        (
            [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.
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: Tenderness to the right shoulder. The right shoulder appears to be dislocated. 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.
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: ***
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] => X Shoulder Rt 3 Views
            [preload_value] => 
        )

    [11] => Array
        (
            [question] => Medications Administered
            [answer] => Dilaudid
            [preload_value] => 
        )

    [12] => Array
        (
            [question] => Radiology
            [answer] => X Shoulder Rt 3 Views: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right shoulder injury
Interpretation: Dislocated Right Shoulder

X Shoulder Rt 3 Views: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Right shoulder relocation
Interpretation: Proper relocation of the right shoulder
            [preload_value] => 
        )

    [13] => Array
        (
            [question] => Procedures
            [answer] => Joint Reduction
The patient was made aware of the risks of a joint reduction including nerve damage and fracture. A right shoulder joint reduction was performed by Dr. ***. The reduction was successful on the first attempt. Capillary refill and radial pulses are unchanged after the procedure. The patient was able to move the right shoulder after the reduction and tolerated the procedure well.
            [preload_value] => 
        )

    [14] => Array
        (
            [question] => Calls/Consults/Rechecks
            [answer] => ***: Rechecked patient who is resting comfortably. 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 male who presents to the emergency department with a chief complaint of a right shoulder injury.  Medical records were reviewed. A right shoulder x-ray was ordered and reviewed. Imaging shows a dislocated right shoulder. A joint reduction was performed by Dr. *** and was successful on the first attempt. A right shoulder x-ray confirmed the proper relocation of the right shoulder. The patient was provided with Dilaudid resulting in improvement of symptoms.  The patient was discharged home with a diagnosis of right shoulder dislocation. The patient was advised to rest and ice the right shoulder. It was recommended for the patient to follow up with Dr. Carter (PCP) as soon as possible.  The patient was provided prescriptions for Vicodin.  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] => Right Shoulder Dislocation
            [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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