PMH, medications, allergies were reviewed.

I have reviewed the MARs.

Social History:

Family History:

Review of Systems:
General: There is no Fever, Chills, Weight Loss or poor Appetite
Pulmonary: There is no history of asthma, emphysema, COPD, increased shortness of breath, cough, wheezing, or sputum production.
Cardiovascular: There has been no heart attack, chest pains, heart surgery, angioplasty, or rapid heart beat.
Genitourinary: No prostate trouble (males) female organ problems (females), bladder trouble, or chronic kidney disease
Gastrointestinal: No ulcers, diarrhea, constipation, blood in the stools, or black stools.
Neurological: There is no history of strokes, TIAs, or migraine headache.
Endocrine: There is no history of diabetes mellitus or thyroid disease.

Physical Exam:

Vital signs were reviewed.

CONSTITUTIONAL:
Eyes: The eyelids are normal and there is no scleral icterus. The pupils are round and equally reactive to light.
MOUTH, EARS, and NOSE: The tympanic membranes are pearly gray. The nasal mucosa is pink with no discharge. The oropharynx is pink with no tonsillar erythema or exudate. There was no evidence of abnormal masses or leukoplakia.
NECK: There is no adenopathy. There are no bruits. There is no JVD.
RESPIRATORY: The breath sounds are equal bilaterally with normal amplitude. There are no crackles, rubs, or wheezes.
CARDIOVASCULAR: The heart sounds are normal. There are no murmurs, rubs, clicks or gallops. The aorta has no mass and no audible bruits.
ABDOMEN: There is no abdominal tenderness. The bowel sounds are normal. There are no abdominal bruits. There are no palpable masses.
MUSCULOSKELETAL: There is no swelling, erythema or warmth of the joints of the fingers, wrists, elbows, shoulders, knees, ankles.
EXTREMITIES: The hands are pink with no evidence of cyanosis. The legs are normal with no evidence of edema or varicosities.
SKIN: There are no abnormal skin rash or masses. There is no focal, abnormal thickening.
NEUROLOGICAL: The cranial nerves 2/12 were normal. The motor examination 5/5 and symmetric.

Impression:

1. 

Plan:

1.  Next blood draw and every 4 months:
CBC, CMP I10
2. Weekly blood pressure and pulse: Call for Systolic blood pressure greater than 220 or less than 90, diastolic blood pressure more than 110. Call for pulse of 140 or greater or less than 50.

Heather Ferron, Scribe

Electronically Signed:
Samuel T. Bowen, MD
NPI: 1568448439
License: NC 003115, VA 0101260751
DEA: BB0930366