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            [0] => a:19:{i:0;a:3:{s:8:"question";s:15:"Chief Complaint";s:6:"answer";s:11:"Altercation";s:13:"preload_value";s:0:"";}i:1;a:3:{s:8:"question";s:26:"History of Present Illness";s:6:"answer";s:1395:"The patient is a 25-year-old male with a history of chronic back pain who presents to the emergency department via EMS with a chief complaint of multiple injuries secondary to an altercation. The patient was recently admitted under the care of Dr. Wallis. At the time of discharge, Dr. Wallis noted that the patient had no homicidal ideation. After he was discharged, the patient was at home where he lives with his aunt and uncle. The patient’s uncle wanted to discuss his admission and the patient was not interested to discuss it at that time. The patient pushed by his uncle in the hallway, when his uncle grabbed his shoulder and turned him around. The patient “clocked” the uncle in the head and the uncle punched the patient in the right eye. The patient tried to tackle his uncle and the uncle pushed him into a wall. The patient’s aunt called the police and the patient locked himself in his bedroom until the police arrived. Upon arrival, the patient complains of right eye pain, nose pain, and left hand pain. His left hand was wrapped by EMS in route. Pain is rated as mild as severity and described as achy with no radiation. There are no aggravating or alleviating factors. The patient denies headache, loss of consciousness, blurred vision, diplopia, chest pain, abdominal pain, trauma to other extremities, or any other symptoms.  No other reported symptoms at this time.";s:13:"preload_value";s:0:"";}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:17:"Chronic Back Pain";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
Smokeless Tobacco - Not Asked
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:15:"Noncontributory";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:2286:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic.  Pupils are 3mm equal round and reactive to light. There is ecchymosis to the inferior lateral aspect of the right periorbital region. There is epistaxis to the right nare. No septal deviation. 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: Ecchymosis noted to the dorsal aspect of the 2nd-5th proximal phalanxes of the left hand. 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:1622:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: ***
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:31:"X Hand Lt 2 View
X Head 
Labs";s:13:"preload_value";s:0:"";}i:11;a:3:{s:8:"question";s:24:"Medications Administered";s:6:"answer";s:7:"Vicodin";s:13:"preload_value";s:0:"";}i:12;a:3:{s:8:"question";s:11:"Lab Results";s:6:"answer";s:6:"Normal";s:13:"preload_value";s:0:"";}i:13;a:3:{s:8:"question";s:9:"Radiology";s:6:"answer";s:151:"X Hand Lt 2 View: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Left Hand Injury
Interpretation: Soft tissue swelling.";s:13:"preload_value";s:0:"";}i:14;a:3:{s:8:"question";s:10:"Procedures";s:6:"answer";s:86:"Ace Wrap Application
An ace wrap was applied to the patient’s left hand by Dr. ***.";s:13:"preload_value";s:0:"";}i:15;a:3:{s:8:"question";s:23:"Calls/Consults/Rechecks";s:6:"answer";s:275:"***: Rechecked patient who is resting comfortably. Imaging and lab results were discussed. The patient will be discharged to his mother’s house. The patient denies suicidal ideation or homicidal ideation at this time. Patient agrees with plan. All questions were addressed.";s:13:"preload_value";s:0:"";}i:16;a:3:{s:8:"question";s:23:"Medical Decision Making";s:6:"answer";s:1041:"The patient is a male who presents to the emergency department with a chief complaint of multiple injuries secondary to an altercation.  Medical records were reviewed. Lab work was ordered and reviewed. Findings stated above.  A left hand x-ray and head x-ray was also ordered and reviewed. Imaging shows left hand soft tissue swelling and a negative head x-ray. The patient was provided with Vicodin resulting in improvement of symptoms. An ace wrap was applied to the left hand and the patient was provided with a left wrist splint.  The patient was discharged home to his mother’s house with a diagnosis of right eye contusion, left hand contusion, and altercation. It was recommended for the patient to follow up with Dr. Wallis (Psychiatry) for an appointment 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:17;a:3:{s:8:"question";s:16:"Final Impression";s:6:"answer";s:53:"Right Eye Contusion
Left Hand Contusion
Altercation";s:13:"preload_value";s:0:"";}i:18;a:3:{s:8:"question";s:4:"Plan";s:6:"answer";s:122:"The patient is discharged to his mother’s house 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 #28 REVIEW: ALTERCATION - AGE 25
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            [0] => May 4, 2019 @ 8:10 pm
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Array
(
    [0] => Array
        (
            [question] => Chief Complaint
            [answer] => Altercation
            [preload_value] => 
        )

    [1] => Array
        (
            [question] => History of Present Illness
            [answer] => The patient is a 25-year-old male with a history of chronic back pain who presents to the emergency department via EMS with a chief complaint of multiple injuries secondary to an altercation. The patient was recently admitted under the care of Dr. Wallis. At the time of discharge, Dr. Wallis noted that the patient had no homicidal ideation. After he was discharged, the patient was at home where he lives with his aunt and uncle. The patient’s uncle wanted to discuss his admission and the patient was not interested to discuss it at that time. The patient pushed by his uncle in the hallway, when his uncle grabbed his shoulder and turned him around. The patient “clocked” the uncle in the head and the uncle punched the patient in the right eye. The patient tried to tackle his uncle and the uncle pushed him into a wall. The patient’s aunt called the police and the patient locked himself in his bedroom until the police arrived. Upon arrival, the patient complains of right eye pain, nose pain, and left hand pain. His left hand was wrapped by EMS in route. Pain is rated as mild as severity and described as achy with no radiation. There are no aggravating or alleviating factors. The patient denies headache, loss of consciousness, blurred vision, diplopia, chest pain, abdominal pain, trauma to other extremities, or any other symptoms.  No other reported symptoms at this time.
            [preload_value] => 
        )

    [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] => Chronic Back Pain
            [preload_value] => 
        )

    [4] => Array
        (
            [question] => Current Medications
            [answer] => None
            [preload_value] => 
        )

    [5] => Array
        (
            [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] => Noncontributory
            [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.  Pupils are 3mm equal round and reactive to light. There is ecchymosis to the inferior lateral aspect of the right periorbital region. There is epistaxis to the right nare. No septal deviation. 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: Ecchymosis noted to the dorsal aspect of the 2nd-5th proximal phalanxes of the left hand. 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: ***
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 Hand Lt 2 View
X Head 
Labs
            [preload_value] => 
        )

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

    [12] => Array
        (
            [question] => Lab Results
            [answer] => Normal
            [preload_value] => 
        )

    [13] => Array
        (
            [question] => Radiology
            [answer] => X Hand Lt 2 View: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Left Hand Injury
Interpretation: Soft tissue swelling.
            [preload_value] => 
        )

    [14] => Array
        (
            [question] => Procedures
            [answer] => Ace Wrap Application
An ace wrap was applied to the patient’s left hand by Dr. ***.
            [preload_value] => 
        )

    [15] => Array
        (
            [question] => Calls/Consults/Rechecks
            [answer] => ***: Rechecked patient who is resting comfortably. Imaging and lab results were discussed. The patient will be discharged to his mother’s house. The patient denies suicidal ideation or homicidal ideation at this time. Patient agrees with plan. All questions were addressed.
            [preload_value] => 
        )

    [16] => Array
        (
            [question] => Medical Decision Making
            [answer] => The patient is a male who presents to the emergency department with a chief complaint of multiple injuries secondary to an altercation.  Medical records were reviewed. Lab work was ordered and reviewed. Findings stated above.  A left hand x-ray and head x-ray was also ordered and reviewed. Imaging shows left hand soft tissue swelling and a negative head x-ray. The patient was provided with Vicodin resulting in improvement of symptoms. An ace wrap was applied to the left hand and the patient was provided with a left wrist splint.  The patient was discharged home to his mother’s house with a diagnosis of right eye contusion, left hand contusion, and altercation. It was recommended for the patient to follow up with Dr. Wallis (Psychiatry) for an appointment 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.
        )

    [17] => Array
        (
            [question] => Final Impression
            [answer] => Right Eye Contusion
Left Hand Contusion
Altercation
            [preload_value] => 
        )

    [18] => Array
        (
            [question] => Plan
            [answer] => The patient is discharged to his mother’s house in stable condition and does not have any further questions or concerns.
            [preload_value] => 
        )

)

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