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            [0] => a:16:{i:0;a:3:{s:8:"question";s:15:"Chief Complaint";s:6:"answer";s:9:"Back Pain";s:13:"preload_value";s:0:"";}i:1;a:3:{s:8:"question";s:26:"History of Present Illness";s:6:"answer";s:913:"The patient is a 30-year-old male with a history of a disc injury and chronic back pain who presents to the emergency department via EMS with a chief complaint of  low back pain. The patient has chronic low back pain that has been progressively worsening since lifting weights a few days ago. His low back pain currently rated as a 10/10 in severity and described as achy with radiation into his left scapula. Associated symptoms include paresthesiass in the bilateral lower extremities. Symptoms are aggravated with movement and there are no alleviating factors. The patient denies bowel or bladder incontinence, lower extremity weakness, other injury, or any other symptoms. He has seen a chiropractor in the past and has also attended physical therapy for his left shoulder. The patient was taking hydrocodone for pain, but states he is currently out of the medication. 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:30:"Chronic Back Pain
Disc Injury";s:13:"preload_value";s:0:"";}i:4;a:3:{s:8:"question";s:19:"Current Medications";s:6:"answer";s:27:"Hydrocodone - Acetaminophen";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:126:"Smoking Status - Not Asked
Smokeless Tobacco - Not Asked
Alcohol Use - No
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:60:"Diabetes - Grandfather
Hyperlipidemia - Father, Grandfather";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:2171:"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 left paraspinal muscular spasm. There is no midline 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 is right suprascapular tenderness. 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 is 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:2037:"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:***
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 is right suprascapular tenderness. 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 is 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:12:"Dilaudid 1mg";s:13:"preload_value";s:0:"";}i:11;a:3:{s:8:"question";s:10:"Procedures";s:6:"answer";s:4:"None";s:13:"preload_value";s:4:"None";}i:12;a:3:{s:8:"question";s:23:"Calls/Consults/Rechecks";s:6:"answer";s:207:"***: Finished physical exam and discussed the plan for discharge. The patient is aware that he needs a ride home if he is administered pain medication. Patient agrees with plan. All questions were addressed.";s:13:"preload_value";s:0:"";}i:13;a:3:{s:8:"question";s:23:"Medical Decision Making";s:6:"answer";s:776:"The patient is a male who presents to the emergency department with a chief complaint of low back pain. Medical records were reviewed. History and physical exam do not warrant any additional testing at this time. The patient was provided with Dilaudid resulting in improvement of symptoms. The patient was discharged home with a diagnosis of chronic low back pain. He was advised to wear a belt while lifting. It was recommended for the patient to follow up with his PCP in one to two days.  The patient was provided prescriptions for Prednisone and Hydrocodone Acetaminophen. 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:14;a:3:{s:8:"question";s:16:"Final Impression";s:6:"answer";s:21:"Chronic Low Back Pain";s:13:"preload_value";s:0:"";}i:15;a:3:{s:8:"question";s:4:"Plan";s:6:"answer";s:183:"The patient is discharged home in stable condition and does not have any further questions or concerns. Discharge instruction attachments include: Back Pain, Hydrocodone Acetaminophen";s:13:"preload_value";s:0:"";}}
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    [patient_video_title] => Array
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            [0] => Mock Patient #4: BACK PAIN - AGE 30
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    [instrucors_video_title] => Array
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            [0] => Mock Patient #4 REVIEW: BACK PAIN - AGE 30
        )

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            [0] => May 4, 2019 @ 6:33 pm
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Array
(
    [0] => Array
        (
            [question] => Chief Complaint
            [answer] => Back Pain
            [preload_value] => 
        )

    [1] => Array
        (
            [question] => History of Present Illness
            [answer] => The patient is a 30-year-old male with a history of a disc injury and chronic back pain who presents to the emergency department via EMS with a chief complaint of  low back pain. The patient has chronic low back pain that has been progressively worsening since lifting weights a few days ago. His low back pain currently rated as a 10/10 in severity and described as achy with radiation into his left scapula. Associated symptoms include paresthesiass in the bilateral lower extremities. Symptoms are aggravated with movement and there are no alleviating factors. The patient denies bowel or bladder incontinence, lower extremity weakness, other injury, or any other symptoms. He has seen a chiropractor in the past and has also attended physical therapy for his left shoulder. The patient was taking hydrocodone for pain, but states he is currently out of the medication. 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] => Chronic Back Pain
Disc Injury
            [preload_value] => 
        )

    [4] => Array
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            [question] => Current Medications
            [answer] => Hydrocodone - Acetaminophen
            [preload_value] => 
        )

    [5] => Array
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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 - No
Drug Use - Not Asked
Sexual Activity - Not Asked
            [preload_value] => 
        )

    [7] => Array
        (
            [question] => Family History
            [answer] => Diabetes - Grandfather
Hyperlipidemia - Father, Grandfather
            [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 left paraspinal muscular spasm. There is no midline 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 is right suprascapular tenderness. 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 is 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:***
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 is right suprascapular tenderness. 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 is 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] => Dilaudid 1mg
            [preload_value] => 
        )

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

    [12] => Array
        (
            [question] => Calls/Consults/Rechecks
            [answer] => ***: Finished physical exam and discussed the plan for discharge. The patient is aware that he needs a ride home if he is administered pain medication. Patient agrees with plan. All questions were addressed.
            [preload_value] => 
        )

    [13] => Array
        (
            [question] => Medical Decision Making
            [answer] => The patient is a male who presents to the emergency department with a chief complaint of low back pain. Medical records were reviewed. History and physical exam do not warrant any additional testing at this time. The patient was provided with Dilaudid resulting in improvement of symptoms. The patient was discharged home with a diagnosis of chronic low back pain. He was advised to wear a belt while lifting. It was recommended for the patient to follow up with his PCP in one to two days.  The patient was provided prescriptions for Prednisone and Hydrocodone Acetaminophen. 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.
        )

    [14] => Array
        (
            [question] => Final Impression
            [answer] => Chronic Low Back Pain
            [preload_value] => 
        )

    [15] => Array
        (
            [question] => Plan
            [answer] => The patient is discharged home in stable condition and does not have any further questions or concerns. Discharge instruction attachments include: Back Pain, Hydrocodone Acetaminophen
            [preload_value] => 
        )

)

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