REASON FOR VISIT:

FOLLOWUP

Since his last visit with

me in March, he has finally now gotten insurance. He has Fidelis Medicaid. He is taking his meds regula
rly, except for the hydrochlorothiazide, which gives him dry, red eyes. He also states his back has been d
oing good. He is now working and otherwise doing great.

PAST MEDICAL, SURGICAL, SOCIAL, AND FAMILY HEALTH HISTORY:

As per February 19, 2019, note.

REVIEW OF SYSTEMS:
As per HPI.

EXAM:
Respirations 14, pulse 96, blood pressure 128/80, height 5 feet 7 inches, weight 273 pounds, BMI 42.
GENERAL: No acute distress.
EYES: PERRL.
ENT: No oropharyngeal lesions.
NECK: Supple, FROM, no lymphadenopathy or thyromegaly.
CV: RRR, nl S1, S2, no murmurs, gallops or rubs, no carotid bruits, good carotid upstrokes, no JVD, 2+
DP bilaterally.
RESPIRATORY: Clear to auscultation bilaterally without adventitial sounds, no dullness to percussion.
BACK: No CVAT, no spinal tenderness.
ABD: NABS, soft, nontender, nondistended, no hepatosplenomegaly, no fluid wave, no abdominal
masses, no hernias.
EXT: No clubbing, cyanosis or edema.
GU: No inguinal lymphadenopathy, masses, or hernias. Bilateral testicles are descended without
masses. Penile shaft without lesions or discharge.
RECTAL: Deferred as per gastroenterology.
SKIN: Unremarkable.
NEURO: Cranial nerves grossly intact. Upper and lower extremity strength grossly intact. Sensation
intact to light touch.
PSYCH: Alert and oriented x3.

IMPRESSION AND PLAN:

1. Hypertension, unspecified. Secondary workup did reveal excess urine hormones, adrenal hormones.
The patient now that he has insurance will schedule his appointment with endocrine and get
the CAT scan done to rule out pheochromocytoma.
2. Obesity. We will discuss this at a later date.
3. Suspected sleep apnea. Now that he has insurance, we will schedule home sleep study.
4. Sickle cell carrier state. Genetic counseling had been provided.
5. Elevated LFTs, which is very significant. He did not get any followup labs done
as he was uninsured. We will recheck LFTs along with a workup and liver imaging.
6. Low vitamin D. We will recheck.
7. Physical in 1 year.
8.
Former smoker. AAA screening was negative. He will require another AAA screening at the age of 65.
9. Marijuana cessation is advised.
10.
Father died at a young age of an aortic rupture at the age of 42. Unclear if this was thoracic or abdominal.
 The patient's abdominal screening was negative. We will go ahead and get an echo to look at the thorax,
to consider chest CT or MRA in the future.
11. Elevated ferritin. We will recheck along with hemochromatosis workup.
12. Abnormal urine white cells. We will recheck.
13. Flu vaccine declined.

KAVITA AGGARWAL, MD

Dictated - 11/18/2019 11:46 Transcribed - 11/18/2019 21:41

Job ID: 204066425/02/02/1985/66685/75282/ARU