record_id,redcap_survey_identifier,new_case_timestamp,echo_identifier,visit_date,presentation_date,patient_id,age,gender,race___0,race___1,race___2,race___3,race___4,race___5,race___6,ethnicity,height_n,weight_n,bmi_n,heart_rate_n,bp_n,patient_care_length,pcp,chief_concerns,adl_1,adl_2,adl_3,adl_4,adl_5,adl_6,adl_7,adl_8,adl_9,adl_10,adl_11,adl_12,caregiver_y_n,caregiver_name,psychiatric_diagnosis___0,psychiatric_diagnosis___1,psychiatric_diagnosis___2,psychiatric_diagnosis___3,psychiatric_diagnosis___4,psychiatric_diagnosis___5,psychiatric_diagnosis___6,psychiatric_diagnosis___7,psychiatric_diagnosis___8,psychiatric_diagnosis___9,psychiatric_diagnosis___10,psychiatric_diagnosis___11,psychiatric_diagnosis___12,other_diagnosis,current_meds,urine_toxicology,what_applies___1,what_applies___2,what_applies___3,i_cope,impact_care,describe_pain,patient_pain_apply___0,patient_pain_apply___1,patient_pain_apply___2,patient_pain_apply___3,patient_pain_apply___4,non_pharm_disc,non_pharm_imp,pharm_disc,pharm_imp,risk_min_strat___0,risk_min_strat___1,risk_min_strat___2,risk_min_strat___3,risk_min_strat___4,risk_min_strat___5,func_treat_goals,social_fam_support,goals_monitor,questions_case,diagnostic_criteria___0,diagnostic_criteria___1,diagnostic_criteria___2,diagnostic_criteria___3,diagnostic_criteria___4,diagnostic_criteria___5,diagnostic_criteria___6,diagnostic_criteria___7,diagnostic_criteria___8,diagnostic_criteria___9,diagnostic_criteria___10,age_sud,motivation,current_drugs___0,current_drugs___1,current_drugs___2,current_drugs___3,current_drugs___4,current_drugs___5,current_drugs___6,current_drugs___7,current_drugs___8,current_drugs___9,current_drugs___10,current_drugs___11,current_drugs___12,current_drugs___13,other_drugs,amount_drug,routes_drugs___0,routes_drugs___1,routes_drugs___2,routes_drugs___3,routes_drugs___4,routes_drugs___5,routes_drugs___6,su_treat_his___0,su_treat_his___1,su_treat_his___2,su_treat_his___3,su_treat_his___4,su_treat_his___5,su_treat_his___6,su_treat_his___7,su_treat_his___8,su_treat_his___9,su_treat_his___10,su_treat_his___11,discharged_patient,discharged_explain,assess_instrum___0,assess_instrum___1,assess_instrum___2,assess_instrum___3,assess_instrum___4,assess_instrum___5,assess_instrum___6,assess_instrum___7,assess_instrum___8,other_instrum,assess_score,meds_following___0,meds_following___1,meds_following___2,amount_med,harm_reduct___0,harm_reduct___1,harm_reduct___2,harm_reduct___3,harm_reduct___4,age_barriers,offered_services___0,offered_services___1,offered_services___2,offered_services___3,offered_services___4,offered_services___5,case_questions___0,case_questions___1,case_questions___2,case_questions___3,case_questions___4,case_questions___5,case_questions___6,case_questions___7,case_questions___8,case_questions___9,case_questions___10,case_questions___11,case_questions___12,case_questions___13,case_questions___14,case_questions___15,question_details,new_case_complete
1,,9/6/21 15:40,OUDPM-001.1-1,9/2/21,9/10/21,WL0812,72,2,0,0,0,0,1,0,0,1,"5'6""",145,23.5,66,139/82,2 years,1,routine follow up visit,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,"amlodipine 5mg daily, chlorthalidone 25mg daily, preservision vitamin daily, methadone 50mg daily (methadone clinic)",no recent UTox results available,0,0,1,0,,,0,0,0,0,0,,,,,0,0,0,0,0,0,,,,,0,0,1,1,0,1,0,0,1,1,1,20s or 30s,none,0,1,0,0,0,0,0,0,0,0,0,0,0,0,,daily nasal heroin use plus methadone,0,0,1,0,0,0,0,0,0,0,0,1,1,0,0,0,0,0,0,0,,0,1,0,0,0,0,0,0,0,,1/9 on PHQ9,0,1,0,50mg daily,1,0,1,0,0,"Pt is a long time heroin user, we talked about evolving risks for synthetic opioids in heroin supply/overdose.   Pt recently switched from IV to nasal heroin and also increased frequency of use, now having a lot more constipation symptoms.",0,0,0,0,0,0,0,0,1,1,0,0,0,0,1,0,0,0,0,0,0,0,"Pt acknowledges harms that heroin use has caused in her life (loss of relationship with son, hepatitis C diagnosis, etc) but does not express desire to quit, feels like she has been able to maintain her heroin usage through most of her lifespan ""why quit now"", what are motivational interviewing tips to help move the patient toward readiness to try quitting  Despite being a long time heroin user, pt recently developed significant constipation, is this just a combo of increased usage plus increasing risk due to age? How best to manage chronic constipation in OUD?",2
2,,9/15/21 16:43,OUDPM-002.1-1,9/14/21,9/16/21,GF0605,54,2,0,0,0,1,0,0,0,1,65 inches,249 lbs,41,89,130,1 visit; New patient,1,"#DJD (Degenerative Joint Disease)  -Starts at C1.   -Trapezius on left side becomes swollen.   -Patient was treated at St Joseph in 2008. She was treated by a pain doctor in 2009 where she was receiving cortisone injections.   -She couldn't get it as often because of Cushing's Syndrome.   -Patient would like to receive treatment for pain at University of Chicago.   -Patient notes occasional numbness or tingling in right arm.   -For patients back pain, she has tried physical therapy.      #BKA (Below Knee Amputation)  -Patient is currently taking oxycodone 5 mg Q4Hr. Patient notes that she started taking it November 2020 after she fell on her stump. ",3,1,3,1,3,1,3,3,3,1,1,1,1,Symphony Rehabilitation Center ,0,0,0,0,0,0,0,1,0,0,0,0,0,,Acetaminophen 1000 mg Q8Hr PRN pain.   Duloxetine 30 mg daily.   Gabapentin 800 mg TID PRN.   Lidocaine 5% ointment as needed for stump pain and back pain.  Amlodipine-Benazapril 5-20 mg daily  Atorvastatin 40 mg bedtime.   Jardiance 10 mg daily  Metformin 850 mg BID with meals  Xarelto 20 mg daily   Calcitriol .25 mcg daily  Melatonin 3 mg daily   Oxycodone 5 mg Q8Hr PRN  Narcan Spray PRN for overdose ,12/07/19  Negative ,0,1,0,0,,"Chronic back pain with intermittent tingling in right arm and swelling of the left trapezius. Patient also notes mild right stump pain which is alleviated with oxycodone and lidocaine. As stated above, back pain was helped by steroid injections in the past but she cannot get them too frequently due to Cushing's syndrome. Physical therapy was not very effective for back pain. Patient is currently in symphony skilled nursing facility. Patient notes that this is temporary. ",0,1,1,0,0,Physical Therapy ,Physical therapy in the past but minimally effective. ,We discussed the goal of slowly weaning down oxycodone from 5 mg Q8Hr to 5 mg Q4Hr. Acetaminophen was increased from 325 mg Q6Hr to 1000 mg Q 8Hr. Patient was initially using lidocaine gel on her stump only. Patient instructed that she may also use it on her back. Current doses of duloxetine and gabapentin were continued. ,As above. ,1,0,0,0,0,0,These were not discussed. ,Patient currently has support in the nursing home staff. Other social supports were not discussed. ,N/A. Will address these at next visit. ,I am wondering how other people wean patients off of chronic opioids when they feel it is unsafe or inappropriate. How have their patients responded? ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
3,,9/16/21 21:41,OUDPM-003.1-1,9/16/21,9/17/21,RN0219,69,1,0,0,0,0,1,0,0,1,6,189,25.6,69,151/69,4 yrs,0,OUD/Tooth Extraction ,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,1,1,0,0,1,0,0,0,0,1,"OUD on agonist, alcohol dependence, benzodiazepine dependence, nicotine dependence","albuterol 2.5mg/3mL nebulizer  albuterol sulfate HFA 90mcg inhaler  Alprazolam 1mg BID (on taper)   Aspirin 81mg chewable  atorvastatin 40mg  Bevespi Aerosphere 9mcg inhaler  buprenorphine 12mg-naloxone 3 mg sublingual film   calcium carbonate 500mg   biktarvy 50mg-15mg tablet   Descovy 200mg-25mg tablet  dulcolax 10mg suppository  Duloxetine 30mg  Ensure Plus 0.05 gram-1.5 kcal/mL oral liquid  ergocalciferol (D2) 1,250 mcg 50,000 capsule   Gabapentin 600mg tablet  glipizide 5mg  ipratroprium-albuterol   megestrol  Narcan   nicotine 4mg gum   nicotine 21mg patch   prednisone 20mg   senna laxative 8.6mg  sodium polystyrene sulfonate oral powder (15mg bid 3 days)   spironolactone 100mg PO daily   tramsulosin 0.4mg capsule   Tiadylt ER 360 mg capsule extended   torsemide 20mg tablet   trazodone 100mg  zolpidem 10mg tablet   "," ====================================================================  TOXASSURE COMP DRUG ANALYSIS,UR  ====================================================================  Test                             Result       Flag       Units    Drug Present    Alprazolam                     387                     ng/mg creat    Alpha-hydroxyalprazolam        268                     ng/mg creat     Source of alprazolam is a scheduled prescription medication.     Alpha-hydroxyalprazolam is an expected metabolite of alprazolam.      Buprenorphine                  111                     ng/mg creat    Norbuprenorphine               630                     ng/mg creat     Source of buprenorphine is a scheduled prescription medication.     Norbuprenorphine is an expected metabolite of buprenorphine.      Gabapentin                     PRESENT    Zolpidem Acid                  PRESENT     Zolpidem acid is an expected metabolite of zolpidem.      Trazodone                      PRESENT    1,3 chlorophenyl piperazine    PRESENT     1,3-chlorophenyl piperazine is an expected metabolite of     trazodone.      Diltiazem                      PRESENT  ====================================================================  Test                      Result    Flag   Units      Ref Range    Creatinine              84               mg/dL      >=20",0,1,1,0,,pt noted most recent pain score of 4 - generalized,1,1,1,0,0,"pt is engaged in motivational interviewing, behavioral management with Navigator   pt is engaged in CBT with BH Provider Briana Gohlke  physical therapy ","pt is engaged in motivational interviewing, behavioral management with Navigator   pt is engaged in CBT with BH Provider Briana Gohlke  physical therapy ","suboxone, gabapentin, narcan","suboxone gabapentin, narcan ",1,1,1,1,1,1,MAR treatment  ongoing BH treatment  physical activity,need more support ,"care team: BH provider, MAT provider, BH Navigator, PCP -                       ",Pt is Long term narcotic user for pain at high levels - eventually transitioned to suboxone - has been reluctant to engaging in higher level of care for SUD. Pt is content with where he is in treatment but risky. Unsure the best way to prioritize treatment for this patient. ,0,1,0,1,1,1,1,0,1,1,1,based on narcotic usage - dx OUD in 2016 ,"pt is motivated to reduce pain.       Followed up with transition of care and introduced myself as new BH provider to his team.  PT reported staying focused on health goals. taking meds as prescribed.    generalized anxiety disorder  Pt takes xanax .5 BID daily. - anxiety around pain and dieing in pain. PT reports anxiety is connected to alcoholic son and son's partner who fight frequently throughout the week. Pt reports coping skills of animals.    opioid dependence  Have continued to discuss opioid taper with PT. PT was able to cut down to approx 32 tabs every 15 days. PT has come down from taking morphine with valek. PT reports some SI when he thinks about being cut off of opioids and being in pain. PT reports means- has access to gun. PT reports waking up in pain and having to take his oxy first thing. PT reports issues with withdrawal symptoms such as diarrhea pt reports that to him ( as he has history of heroin use disorder and experience a lot of withdrawal) is not withdrawal.    history of heroin abuse  PT reported last heroin use was in 1970s.    moderate recurrent major depression  Pt has suicidal ideation connected to pain and loss of pain medication - pt reported commitment to safety in short term as he has pain meds.    opioid dependence, on agonist therapy  PT doing well in suboxone program - pt reports better mobility.",1,0,0,1,1,0,0,0,0,1,0,0,0,0,,on rx bup -   drinking unsure   benzos on a taper - current 1mg BID down from - 4mg daily ,1,0,0,1,0,0,0,0,1,1,1,0,0,1,1,0,0,1,0,0,,0,1,1,0,0,0,0,1,1,"ASAM, SOWS ",PHQ - moderate/mild   GAD  - moderately severe  DSM5 - OUD     ,1,0,0,4mg suboxone on taper  .5-1mg BID xanax on taper,1,0,1,0,1,"pt has mobility issues due to age and medical conditions, which exacerbate pain - pt has an idea that as long as he has access to pain meds he can function; does not associate non-pharmacological interventions as useful for pain mgmt. ",1,1,1,1,1,0,0,0,0,0,0,0,0,1,1,0,0,0,1,1,1,0,"Followed up with transition of care and introduced myself as new BH provider to his team.  PT reported staying focused on health goals. taking meds as prescribed.    generalized anxiety disorder  Pt takes xanax .5 BID daily. - anxiety around pain and dieing in pain. PT reports anxiety is connected to alcoholic son and son's partner who fight frequently throughout the week. Pt reports coping skills of animals.    opioid dependence  Have continued to discuss opioid taper with PT. PT was able to cut down to approx 32 tabs every 15 days. PT has come down from taking morphine with valek. PT reports some SI when he thinks about being cut off of opioids and being in pain. PT reports means- has access to gun. PT reports waking up in pain and having to take his oxy first thing. PT reports issues with withdrawal symptoms such as diarrhea pt reports that to him ( as he has history of heroin use disorder and experience a lot of withdrawal) is not withdrawal.    history of heroin abuse  PT reported last heroin use was in 1970s.    moderate recurrent major depression  Pt has suicidal ideation connected to pain and loss of pain medication - pt reported commitment to safety in short term as he has pain meds.    opioid dependence, on agonist therapy  PT doing well in suboxone program - pt reports better mobility.",2
4,,9/22/21 19:57,OUDPM-004.1-1,9/8/21,9/24/21,SD0346,75,2,0,0,0,0,1,0,0,0,61,124,23,82,126/74,"1 visit, New patient",1,"Establish care, HTN and cholesterol follow up.   Hx of recent fall, had total right hip replacement in Mexico three weeks prior to my visit. Patient with complaints of hip pain, takin Tylenol 650 mg PRN.  Family concerned about her mobility.  Patient unable to ambulate, has been using wheel chair since her surgery. Family reported she was unable to tolerate physical therapy due to poor pain control.  She was prescribed narcotics post op, patient declined to take them.   ",3,1,3,3,3,3,3,3,3,3,3,3,1,Daughter ,0,0,0,0,0,0,0,0,0,0,0,0,0,,"Lisinopril 10 mg QD, Simvastatin 20 mg QD,  Acetaminophen 650 mg PRN. ",,1,1,0,0,,"Chronic back pain, achy,  spasms, with intermitted radiation to lower extremities. The pain increased with increased mobility, has improved since her surgery due to being less active.  Acute right hip pain, sharp, achy, throbbing pain with increased movement. Patient unable to stand on her own or ambulate without assistance. Pain is constant, Tylenol not being very effective in controlling her pain. Unable to tolerate PT due to poor pain control .",1,0,1,0,0,Physical Therapy,Physical Therapy,"Our goal was to better control her acute pain. The goal is to make her comfortable enough to be able tolerate Physical therapy and get her out the wheel chair.  Acetaminophen dose was increased to 1000 mg at scheduled times, not PRN. We discussed the possible need to initiate Norco if pain levels remained the same, patient declined. She agreed to Diclofenac topical.  Patient very hesitant about takin pain medications. ","Acetaminophen 1000 mg PO Q6 hrs,  Diclofenac topical BID. ",0,0,0,0,0,0,"Better pain control to tolerate Physical therapy. Patient will be able to stand,  ambulate independently, independent ADLs, increase activities similar to or better prior to her fall. ","Daughters are very involved in pt's care. Patient currently fully dependent for ADLs.  Family will help with medications administration, transportation and constant surveillance of patient's progress   ",Will address at next visit.,"In dealing with patients who are very hesitant about taking pain mediations, how do you help them overcome these fears and concerns when clearly their pain levels are deterring them from living a better quality of life?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
5,,9/22/21 21:57,OUDPM-005.1-1,8/31/21,9/24/21,DC1010,71,1,0,0,0,0,1,0,0,,6 f,235 lb,,,,10 Y,1,"Follow up for his chronic conditions ,  concern about  pain  and  want increase pain medication.",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,1,alcohol abuse ,"HYDROcodone-acetaminophen (NORCO) 7.5-325 mg per tablet  po q 8 h.  budesonide-formoteroL (SYMBICORT) 160-4.5 mcg/actuation inhaler 2 puff bid .  albuterol (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation inhaler.  atorvastatin (LIPITOR) 40 mg tablet .  furosemide (LASIX) 20 mg tablet .  carvediloL (COREG) 25 mg tablet po BID .  irbesartan (AVAPRO) 300 mg tablet.   amLODIPine (NORVASC) 5 mg tablet.  tiotropium (SPIRIVA) 18 mcg inhalation capsule.  naloxone 4 mg/actuation Spry.   Cholecalciferol, Vitamin D3, (VITAMIN D) 1,000 unit Cap.  ASA 81 mg .      ","9/9/21    REPORT SUMMARY	FINAL   Comment: ====================================================================   TOXASSURE SELECT 13 (MW)   ====================================================================   Test                             Result       Flag       Units     Drug Present     Hydrocodone                    3804                    ng/mg creat     Hydromorphone                  743                     ng/mg creat     Dihydrocodeine                 435                     ng/mg creat     Norhydrocodone                 1491                    ng/mg creat      Sources of hydrocodone include scheduled prescription      medications. Hydromorphone, dihydrocodeine and norhydrocodone are      expected metabolites of hydrocodone. Hydromorphone and      dihydrocodeine are also available as scheduled prescription      medications.     ====================================================================   Test                      Result    Flag   Units      Ref Range     Creatinine              23               mg/dL      >=20   ====================================================================   Declared Medications:     ",0,1,0,0,,"daily pain ,  upper  and mainly lower  back , daily  knee pain  bilateral ,  also  bilateral pain  legs .  pain described as severed ,  associated to stiffness improve  during  day some times and  increased again at night time ,  it is  sharp  achy  and  many times  is present  during  day as well.   pain in his legs is  more  burning type  and shooting type some times ",1,1,1,0,0,PT.  Yoga ,NONE,gabapentin. lyrica  topical NSAIDs .  topical analgesics (patches)  pain clinic  for injections and other therapies ,topical NSAID   Gabapentin .  Unchange dose Norco ,1,1,1,1,0,0,pain control  during the day to keep his  functional status and independency .  No to increase  Narcotic use.   ,"Patient lives  by himself , there is not  family  member in town , he has  some  friends around.",,Lately  patient  always  wants his Narcotic's dose to be increased. what alternatives we have ?   is buprenorphine  and option?,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
6,,9/28/21 8:26,OUDPM-006.1-1,9/10/21,10/1/21,JS0414,82,1,0,0,0,1,0,0,0,1,"5'10""",146lb,20,76,109/59,3 weeks,1,"Establish care with new provider in clinic. Family concerned about patient's heroin use, hospitalizations, and cognitive decline. Patient's chief complaint - right foot pain 2/2 bunion",1,1,1,1,1,1,1,1,2,1,1,1,0,,1,0,0,0,0,0,0,0,0,0,0,0,0,,Albuterol PRN  Aspirin 325mg daily  Atorvastatin 40mg daily  Cyanocobalamin 1000mcg daily  Flonase daily  Folic acid 1mg daily  MV  Vitamin B6 100mg daily  Thiamine 100mg daily  Narcan rx on 9/10/21,Did not get at our visit. Previous +opiates ,0,0,1,0,,,0,0,0,0,0,,,,,0,0,0,0,0,0,,,,,0,0,0,0,0,1,0,1,1,0,1,38yo (44 years of heroin use),"Pre-contemplation stage, which does not align with the family who is in the preparation stage and hoping to put a plan into action as soon as possible.",0,1,0,0,0,0,0,0,0,0,0,0,0,0,,1-2 bags of heroin a day.,0,0,1,0,0,0,0,0,0,1,0,0,0,0,0,0,0,0,0,0,,0,0,0,0,0,0,0,1,1,GDS,DSM-5: 2  GDS: negative screen,0,0,0,,1,0,0,0,0,"Concern for dementia, concern for inability to care for self without additional support",0,0,0,0,1,1,0,0,0,0,1,1,0,0,1,1,0,0,0,0,0,0,"Questions:   1. How have you/would you navigated his perhaps inability to acknowledge the problematic nature of his heroin use due to likely dementia? And subsequent unwillingness to consider MOUD? All while family is hoping to start ASAP. Any tips?  2. What induction methods have you used in patients with cognitive impairment, who live alone, who do not have a caregiver, and concern for their ability to take medications reliably? (admit to hospital, daily visits for clinic induction, etc)",2
7,,9/29/21 15:12,OUDPM-007.1-1,9/28/21,10/8/21,DH0618,54,2,0,0,0,1,0,0,0,1,5'3,200,34.9,70,132/58,This is a pt of my colleague 4/2020,1,Medication refills,1,1,1,1,1,3,3,3,3,1,1,1,0,,1,0,0,0,1,0,0,1,0,0,0,0,1,Opioid dependence,mirtazapine 15mg 1x daily  Narcan 4mg intranasal PRN  hydrochlorothiazide 12.5mg 1x daily  meloxicam 15mg 1 tab as needed  sertraline 100mg 1x daily  albuterol sulfate HFA 90mcg/actuation aerosol inhaler,"5/28/21  Positive for xanax, cocaine, heroin, tramadol, and fentanyl",0,1,1,0,,Red blotches on feet/hands that sting  chronic pain in both legs- sharp pains in the night then aching.   Pain in feet when walking- unable to walk more than a few minutes. Recent fall due to swelling in feet,0,1,0,0,1,Increase physical activity.   Referral to rheumatologist,Referral to rheumatologist,Buproprion and Suboxone and mirtazapine,Buproprion (discontinued) and Suboxone(discontinued) and mirtazapine,1,0,1,1,0,0,Unknown,Pt's sister also abuses substances and influences pt to abuse. Family is verbally supportive of pt but will not change their lifestyle with this pt. ,Follow up visits with provider and substance use care manager,Are there additional referrals that are recommended? How to help when the patient is surrounded by opioid users. ,1,1,1,1,1,1,1,1,1,1,1,2006,"""To get my life back."" Pt wants to get up and work and stop wasting money.",1,1,0,0,1,1,0,0,0,1,0,0,0,0,,Unknown,1,0,1,1,0,0,0,0,1,0,1,1,1,0,0,0,0,1,0,0,,0,1,1,0,0,0,0,0,0,,PHQ-9: 0 (score of 24 with SI in 6/2021)  GAD-7: 0,0,0,0,,1,0,0,0,0,None noted,1,1,1,1,1,0,0,1,1,0,0,0,0,1,1,1,0,0,1,0,0,0,,2
8,,10/7/21 20:44,OUDPM-008.1-1,9/10/21,10/8/21,SL1002,75,2,0,0,0,0,1,0,0,1,5 ft 1 in,98 lbs,18.52,94,125/72,one month. one visit.,1,"Hospital follow up from last month, where the patient went in for lower abdominal and pelvic pain, intermittent vaginal bleeding and urinary difficulties and was newly diagnosed with uterine cancer with metastasis to bladder, lung and liver. She needed referrals for planned chemo and radiation and requested refill on Norco 10. ",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,,"nicotine patch 21 mg/24 hr  ibuprofen 800 mg q 8 hrs prn  norco 10 q 6 hrs prn  ropinirole 0.25 mg qhs  ciprofloxacin-short course    was on tylenol, lidocaine patch, voltaren gel, Bentyl, docusate, miralax, and lexapro. ",no recent urine toxicology,0,1,0,0,,"pelvic/lower abdominal pain, severe, constant. no associated manifestations. ",1,0,0,0,0,none,none,patient requested norco,refilled norco x 7 days,0,1,0,0,1,1,n/a,n/a,n/a,How aggressively should I (start to) treat the pain of a cancer patient with poor prognosis who has not deconditioned yet. She quickly stopped other hospital-started pain treatments and stayed with only norco. How should I assess and change plan as her function/condition changes? How much is too much opiate pain med? When to refer to pain management? Patient declined hospice at this time. what is the role of hospice service in pain management?,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
9,,10/13/21 17:08,OUDPM-009.1-1,,10/15/21,CA0223,62,1,0,0,0,0,0,0,1,0,67,216,33,83,128/64,4 years,1,"The patient has had 12 surgeries on his lower extremities. Born with a right foot deformity, had surgery after birth, another at age 18. 7 years ago he was hit by a truck, damaging his left leg, also suffered a GSW to left ankle. Often has generalized pain, or head pain, or abdominal pain (squeezing) and lower extremity pain. He was on Norco when I first met him in 2016. That clinic closed, and he went to another clinic where he was weaned off Norco. I have been seeing him regularly since 2017--recently he has asked for norco again, and I have prescribed it to him. ",1,1,1,1,1,3,3,3,3,1,1,1,2,,0,0,1,0,1,0,0,0,0,0,0,0,0,,"Celebrex 200 bid, norco 5/325 bid, risperidone 1 mg qhs, buspirone 10 mg tid, gabapentin 800 mg tid, lisinopril 40 qd, omeprazole 40 qd, amlodipine 10 mg qd",not done,0,1,0,0,,"Pain is constant, very sharp, foot, back, head, and sometimes in arms. ",0,0,0,0,1,"I would like him to try tai chi, accupuncture",Physical therapy several years ago,I am considering switching the norco to buprenorphine/naloxone,"Currently on celebrex, hydrocodone/acetaminophen, gabapentin.  smokes marijuana once or twice a week (not medical MJ).",0,1,0,0,0,1,"Pt is aware that a pain-free state will not be attainable. Goals are to find joy daily, in nature, especially in his birds","Limited. He has a homemaker, but does not speak of her much. He talks to his mother on the phone. ",Regular visits to the clinic. ,What are the benefits of switching to suboxone? Would that be recommended?  How to convince someone who is hesitant to attend non-pharmacologic therapies. ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
10,,10/11/21 1:03,OUDPM-10.1-1,3/18/17,10/15/21,JG0000,71,1,0,0,0,0,1,0,0,1,67,222,34.8,80,128/82,20,1,"Chronic pain, arthropathie,  DM2, high BP CRF CR2.5 +HCV RX 2015, psoriasis   SP R hip revision, l THR, R total shoulder , L TSR",1,1,3,3,1,2,3,3,3,2,2,1,1,Wife,1,1,0,0,0,0,0,1,0,0,0,1,0,,"Norco 7.5 mg 2-4/day, methadone 40-60 mg,  Thyroxine 0.075 wan , lisinoprik 1/2 to 1 qd, risperdal 1 mg, Xanax 1 mg  qd, lamotrigine 150 mg qd, Allegra 180 mg  po pen, fluticasone topical.005%, Vit D 50,000  weekly  ",,0,1,0,0,,Pain in shoulders hip back varies 6-10 worse with movement,0,1,1,0,0,"Exercise , topical tried ",Exercise,Decreasing opioids ,,0,0,0,1,0,0,,Wife supportive and controls narcotics ,Follow up4-6 weeks,What other modalities ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
11,,10/19/21 15:00,OUDPM-11.1-1,10/18/21,10/22/21,RN0219,69,1,0,0,0,0,0,0,0,,6ft,189,25.6,73,151/69,15 Gen meds   13 months in MAR ,0,Was recently hospitalized at a local tertiary hospital fx phalanx foot and was treated with narcotics. Here today requesting additional narcotic medication . Pt is currently enrolled on agonist treatment . ,1,1,1,1,1,1,1,1,1,1,1,1,0,,1,0,0,1,1,0,0,1,0,0,0,0,0,,polypharmacy  See attached medication list ,9/6/21 pos for norbuprenophine  ,1,1,1,0,,"Low back pain, chronic     Pain lower extremities secondary to diabetic neuropathy ,   acute foot pain d/t fx phalanx foot   s/p ORIF left femur  1/2021",0,1,1,1,0,"PT, exercises, local physical agents,  topical agents, ","Had PT,  exercises, local physicals agents, topical agents",Suboxone 12-3mg sub lingual film  q 12hrs Duloxetine 30mg q d   Hydrocodone 5mg- 325mg acetaminophen  1 tablets q 12hrs for break through pain.   Xanax 1mg bid for GAD ,Suboxone 12-3mg sub lingual film q 12hrs  duloxetine 30mg q d  Hydrocodone 5mg -325mg acetaminophen 1 tablet q 12hrs for break through pain   Xanax 1 mg  q 12hrs for GAD ,1,1,1,1,0,1,achieve pain level tolerable for functional ADLS and IADLS.  Wean off narcotics   Gradually wean off  Benzos    Continue in BH  Therapy ,"Divorced  ex-wife transitioned 2/ 2021   Lives in his house with middle son , his girlfriend, their 18 y/o son  and another 5 y/o son. Son and girlfriend drink a lot, argue and fight. This is stressful for him. Also feels too sick to baby sit grand son as parents are gone for long hours. Son was unemployed for a long time  and recently found work . He now helps with chores and housekeeping. Patient feels son is alcoholic   and is refusing care.      ",Monthly visit or more as needed.   Urine Toxicology for compliance  Monitor pain level   FUNCTIONAL ASSESSMENT  ,"69 y/o male with complex medical needs ( medical, behavioral and Social. His OUD has been successfully managed by agonist treatment for over a year . Is it ok to switch him to a long acting agonist such as sublocate giving the fact this may help control pain. Appreciates suggestions on reducing polypharmacy in this complex patients with a host of serious and life threatening conditions.  ",0,0,0,1,1,1,1,1,1,1,0,Hx of  IV Heroin use and alcoholism at age 21.  Had 5 overdoses and 12 MVAs . Methadone treatment x 3yrs  Cold turkey at age early 30s  for herion. Stopped drinking in his early 40s when he was diagnosed with Cirrhosis.  ,highly motivated. No heroin use for  over 30 yrs.  No alcohol  use for  about 30 yrs.  ,0,0,1,0,1,0,0,0,0,1,0,0,0,1,Opiod agonist treatment. Buprenorphine    Xanax  Nicotine patch ,Buprenorphine sublingual film 12-3mg  p o  bid   Xanax  0.5mg bi d ,1,0,0,0,0,0,0,0,1,0,0,0,1,1,0,0,0,1,0,0,,0,1,1,0,0,0,0,0,0,,PHQ9  was 2  on 10/8/21   GAD was 6  on 10/8/21 ,1,0,0,12-3mg  sublingual film q 12 hrs ,1,0,1,0,0,Poor Family support   Living condition   possible transportation issue- existing  car was wrecked in accident six weeks ago. ,1,1,1,0,0,0,0,0,0,0,0,1,0,0,1,1,0,1,1,0,0,0,"69 y/o male with hx of  IV Heroin for about a decade and survived 5 overdoses . Drinker x 2 decades with alcohol induced cirrhosis and 12  MVAs attributed to DUI. Now has chronic pain, recurrent major depression, GAD, HTN, uncontrolled DM with diabetic neuropathy,  Stage3 CKD, Hyperlipidemia, COPD, Tobacco use disorder, Solitary pulmonary nodule r/o Ca Lung , smoker for 56 years 1 ppd, Chronic pain, Benzodiazepine  dependency, GERD , Aortic Aneurysm, Osteoporosis with frequent falls, Vitamin D deficiency , Loss of vision in one eye with decreased visual acuity in the other. Significant hx of Trauma and OUD on agonist treatment, AOU is controlled  . He attends U of C for tertiary care ( infectious disease, pulmonologist, cardiologist, nephrologist , neurologist and gastroenterologist . Currently, experiencing acute pain secondary to fx foot sustained in a MVA about 6wks ago. Will refer to the ophthalmologist for possible diabetic retinopathy  as possible reason for his frequent falls. ",2
12,,10/19/21 22:52,OUDPM-12.1-1,6/7/21,10/22/21,JD0139,82 years,2,0,0,0,0,1,0,0,1,5 ft 3 in,80 kg,31.2 kg/m2,99 bpm,135/88 mmHg,first time,0,Pain in right elbow after a fall.  Patient slipped over concrete on the beach and hit her right arm/elbow. Presented 2 days later as the pain was not subsiding and was worse with movement.,1,1,1,1,1,3,1,1,3,1,1,1,0,,0,0,0,1,0,0,0,1,0,0,0,0,0,,amlodipine 5 mg daily  metformin 500 mg BID  docusate senna daily PRN  Acetaminophen 1 g Q8H PRN  diclofenac gel PRN  Tramadol 50 mg PRN (husband's medication from most recent hospital discharge),negative,1,1,1,0,,"1. right elbow and arm  2. dull, constant pain with intermittent spikes of sharp pain  3. 6/10 at rest, 10/10 with movement  4. since 2 days (after the fall)  5. in all environments/settings  6. worse with movement, unable to lift any weights, no alleviating factors  7. no numbness/tingling/motor or sensory deficits distally",1,0,1,0,0,alternating heat therapy with icing,Cold therapy with ice pack,"Continuing acetaminophen scheduled for a week, Ibuprofen Q8H PRN for severe pain, Norco 5 (Hydrocodone/acetaminophen) Q8H PRN","Continuing acetaminophen scheduled for a week, Ibuprofen Q8H PRN for severe pain, Norco 5 (Hydrocodone/acetaminophen) Q8H PRN",0,1,1,0,0,1,optimal pain control with minimal use of and eventual discontinuation of opioid use and regaining full function of right elbow/arm,Reaching out to provider when needed if the patient could not do it herself; taking patient for elbow X-ray and to doctor appointments ,Assist the patient to set up appointments for X-Ray and physician visits  Communicate over telephone regarding test/x-ray results  Set up a sooner follow up visit  Physical/Occupational therapy if needed,How would you immediately treat the pain if the patient is known to have OUD and we do not have imaging findings available yet?  What would be the pain control options post surgery?  Should we start opioids at a higher dose to achieve pain control given history of OUD?,1,0,0,1,0,0,0,1,0,1,0,50 years,Previously achieved recovery and understood risk involved with persistent opioid use  Understood that her husband who has early stage dementia needs help at home and therefore she needs to recover soon,1,0,0,0,0,0,0,0,0,1,0,0,0,0,,Tramadol 50 mg as needed (used husband's medication that was prescribed after hospital discharge)  Tobacco smoking 1 pack per day since almost 50 years,1,0,0,1,0,0,0,0,0,0,1,0,1,0,0,0,0,0,0,1,Patient recalled being with a methadone program about 5 years ago. She was eventually tapered off of methadone 2-3 years ago,0,0,1,0,0,0,0,0,0,,GAD-7 score: 5 points (mild anxiety disorder),0,0,0,,0,0,1,0,0,Ability to use technology to instantly communicate with providers (such as using MyChart).  Requires assistance for transport to healthcare appointments.  Having to take care of husband at home who has early stage dementia.,1,0,0,0,0,0,0,1,1,0,0,0,0,0,0,0,0,1,1,0,0,0,Ensuring adequate pain control while avoiding dependency on opioids.  Making sure the patient does not take someone else's opioids and consults her healthcare provider in such situations.,2
13,,10/29/21 0:13,OUDPM-13.1-1,10/22/21,10/29/21,GH0823,67,1,0,0,0,1,0,0,0,1,"6'3"" (190.5cm)",175 lb (79.4 kg),21.8,66,111/78,Met pt on 10/22/2021,1,I was asked to see pt for help with placement and establish capacity/POA. ,1,1,1,1,3,2,2,2,3,1,2,1,0,,1,0,0,0,0,0,0,0,0,0,0,0,0,,"buprenorphine-naloxone (SUBOXONE) 8-2 mg sublingual film	Place 2 Film under the tongue every morning.  buprenorphine-naloxone (SUBOXONE) 4-1 mg sublingual film	Place 3 Film under the tongue EVERY EVENING.  naloxone (NARCAN) 4 mg/actuation nasal spray	Use 1 spray in one nostril once as needed for overdose.  folic acid 1 mg tablet	Take 1 tablet by mouth every 24 hours  Levetiracetam 1,000 mg tab	Take 1 tablet (1,000 mg) by mouth twice daily.  pyridoxine (vitamin B6) 100 mg tablet	Take 1 tablet by mouth daily.  thiamine 100 mg tab	Take 1 tablet by mouth daily.","Ethanol Screen	NONE DETECTED 	  Amphetamine Screen	NONE DETECTED 	  Barbiturates Screen	NONE DETECTED 	  Benzodiazepines Screen	NONE DETECTED 	  Cocaine Metab. Screen	NONE DETECTED 	  Opiates Screen	POSITIVE 	  Phencyclidine Screen	NONE DETECTED 	  Methadone Metabolite Screen	NONE DETECTED 	  Oxycodone Screen	NONE DETECTED 	  Salicylate                <1.0",0,0,1,0,,,0,0,0,0,0,,,,,0,0,0,0,0,0,,,,,1,1,1,1,1,1,1,1,1,1,1,19 yrs,"Patient states that this hospitalization was a wake-up call for him, because he thought he was dying, and decided he did not want that.  He wants to get away from this lifestyle.  He needs to be around for when he wife gets out. ",1,1,1,0,0,0,0,0,1,0,0,0,0,0,,"What ever he can afford, his landlord give it to him  gotten up to IV/IN $300/day , but usually less",0,1,1,0,0,0,0,0,1,1,1,0,1,0,0,0,0,0,0,0,,0,0,0,0,1,0,0,1,0,,On initial arrival COWS -9   On my encounter COWS -0,1,0,0,"buprenorphine-naloxone (SUBOXONE) 8-2 mg sublingual film	Place 2 Film under the tongue every morning.  buprenorphine-naloxone (SUBOXONE) 4-1 mg sublingual film	Place 3 Film under the tongue EVERY EVENING.",1,0,1,0,0,"After pt's seizures and infection were addressed and had underwent a cardiac work up, he was driven in Haymarket Inpt treatment; however, he never got out of the vehicle as he is dependent of some of his ADLs, including having difficult walking.   His landlord has pt's check coming directly to her.    Difficult finding a place to accept pt long term. ",1,1,1,1,1,0,0,1,1,0,0,0,0,0,1,0,0,0,0,0,0,0,"Patient states that his substance started at age 19 and has continued since that time.  Started out as weekly using both heroin and cocaine, stopped cocaine because he did not have the money for both.  Patient notes that he has been on methadone before, but he started selling the methadone on the street so he could use the money to buy heroin.  Has never done inpatient rehab, has never participated in support groups like Narcotics Anonymous.  Has OD'ed before not able to quantify it.      Patient states that he has 2 sons but did not raise them, was in a part of their lives.  He does have a wife who is in jail, does not know when she will be getting out.     Patient states that he rents a room out from his heroin supplier.  She takes some money out for rent and the rest of of the check is given to him in heroin.  He states that at times he has to get heroin with credits so that he is continuously indebted to his supplier.  His room does not have any cooking facilities.  He needs to go up 2 flights of stairs to get to his room.  He has to rely on someone taking down his walker or bringing it back up to leave his building.  He does go up and down the stairs to pick up his Meals on Wheels which takes him quite a bit of time each way.  He sleeps on the floor, and uses the chair in his room to pull himself up.  MHx of TBI, seizure d/o and substance use d/o, brain aneurysms s/p L craniotomy, Lung nodule, positive HCV with 100k+ viral load   Stayed in the hospital 2 extra days (on 1st admit) complaining of feeling ""funny"" and requesting more seizure medication  Primary team requesting state guardian because pt is an addict. ",2
14,,1/13/22 9:55,OUDPM-14.1-2,10/15/21,1/14/22,BR0731,67,1,0,0,0,1,0,0,0,2,170 cm,72 kg,24.8,66,132/59,1 y,1,Diabetes; chronic left shoulder pain secondary to history of incomplete tear of rotator cuff; autoimmune pancreatitis,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,1,0,0,0,0,0,0,0,0,0,0,0,,"MS Contin 15 mg PRN, Tramadol 50 mg Q8H PRN, Diclofenac gel, Robaxin 750 mg TID PRN, Gabapentin 300 mg BID, Trileptal 600 mg BID, Zolpidem 10 mg nightly PRN, Diazepam 10 mg BID PRN, Tamsulosin 0.4 mg BID, Bethanechol 10 mg TID, Lantus, Novolog, Atorvastatin 20 mg nightly, Prednisone 10 mg daily, Montelukast 10 mg nightly, Albuterol PRN",Tramadol and benzodiazepines,0,1,0,,,"Left shoulder: achy, 0-10/10, constant and undulating worse with activity.   Abdomen: RUQ/epigastric, crampy, 10/10 sudden attack a few times per year.",1,0,0,0,1,Shoulder - none. Abdomen - GI consultation pending,n/a,"Patient requested refill for Tramadol for shoulder pain. Patient requested refill for Morphine, 30 mg tablets and a larger number of pills.",,0,1,0,0,0,0,n/a,n/a,n/a,"Patient has polypharmacy with multiple high risk medications. Patient also strongly believes he knows what is the best treatment for him, and visits get derailed on topics such as Morphine Rx. Where to start in reducing his risk of harm? Titrate off Tramadol? Refuse Morphine altogether?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
15,,1/13/22 17:14,OUDPM-15.1-2,7/6/21,1/14/22,EG0520,56,2,0,0,0,1,0,0,0,1,1.626 m,138.3 kg,52,91,131/84,Since 3/22/2021,1,"""Medication refill""",1,1,3,1,1,3,3,3,3,1,1,1,0,,1,0,0,0,0,0,0,0,0,0,0,0,0,,"Current Outpatient Medications:  •  albuterol (PROVENTIL) 2.5 mg /3 mL (0.083 %) nebulizer solution, USE 1 VIAL BY NEBULIZATION EVERY 6 HOURS AS NEEDED FOR WHEEZING, Disp: 75 mL, Rfl: 2  •  albuterol (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation inhaler, INHALE 2 PUFFS INTO THE LUNGS EVERY 6 HOURS AS NEEDED FOR WHEEZING, Disp: 18 g, Rfl: 3  •  HYDROcodone-acetaminophen (NORCO) 7.5-325 mg per tablet, TAKE 1 TABLET BY MOUTH EVERY 8 HOURS AS NEEDED FOR PAIN, Disp: 90 tablet, Rfl: 0  •  amLODIPine (NORVASC) 10 mg tablet, Take 1 tablet by mouth daily., Disp: 90 tablet, Rfl: 3  •  clopidogreL (PLAVIX) 75 mg tablet, TAKE ONE TABLET BY MOUTH ONCE DAILY, Disp: 90 tablet, Rfl: 3  •  atorvastatin (LIPITOR) 40 mg tablet, Take 1 tablet by mouth daily., Disp: 90 tablet, Rfl: 1  •  aspirin 81 mg EC tablet, Take 1 tablet by mouth daily for 360 days., Disp: 90 tablet, Rfl: 3  •  insulin NPH-insulin regular (HUMULIN 70/30 U-100 INSULIN) 100 unit/mL (70-30) injection, Inject 70 Units into the skin daily (with breakfast) AND 30 Units daily (with dinner)., Disp: 100 mL, Rfl: 0  •  cyclobenzaprine (FLEXERIL) 5 mg tablet, Take 1 tablet by mouth daily as needed for Muscle spasms., Disp: 30 tablet, Rfl: 1  •  fluconazole (DIFLUCAN) 150 mg tablet, TAKE 1 TABLET BY MOUTH ONCE FOR 1 DOSE., Disp: 3 tablet, Rfl: 0  •  metFORMIN (GLUCOPHAGE) 1,000 mg tablet, TAKE ONE TABLET BY MOUTH 2 TIMES A DAY WITH MORNING AND EVENING MEALS,",None ever done,0,1,0,0,,"Lower back, uncertain, 10/10, waxing/waning (good days/bad days), ?, exacerbated by walking/physical activity, pain all over",0,0,0,0,1,"Physical therapy, surgery",Physical therapy,"Muscle relaxant, Opioid","Muscle relaxant, Opioid",0,1,0,0,0,0,GOAL is walking in park comfortably  Can only lift 5-10 lbs maximum and not for long -- was unable to pick up 5-month old great grandchild (also a GOAL),,,"I think I know how to characterize pain and offer more than opioids and muscle relaxants, but every visit -- I felt that I never had the time to thoroughly chart review this patient and it was a struggle to focus thoroughly on any one thing. What behavioral techniques might have helped me provide better care to this patient (this patient doesn't even have a follow up appointment)?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
16,,1/19/22 21:49,OUDPM-16.1-2,11/5/21,1/21/22,BM1124,81,1,0,0,0,0,1,0,0,0,5'5'',165 lb,27.5,95,148/60,first visit,0,hospital follow-up for anemia and gastric ulcer,1,1,1,1,1,1,1,1,1,1,1,1,1,Daughter,0,0,0,0,0,0,0,0,0,0,0,0,0,,Lisinopril 20mg daily  Ferrous sulfate 325mg daily  Pantoprazole 40mg daily  Meloxicam 15mg daily,None,0,1,0,0,,"Chronic pain in right knee and left foot/ankle for many years, improved only with NSAIDs",1,0,0,0,0,Dietary changes,Dietary changes,Tylenol...then diclofenac gel...then celebrex,All of the above,0,0,0,0,0,0,Improvement in pain so can walk normally,"Helping with dietary modifications, medication compliance",By patient,"Options for nonpharmacologic pain management - supplements, acupuncture, cupping, etc - when other nonopiate pain meds are contraindicated? How to find reputable providers/suppliers for these things?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
17,,1/22/22 18:19,OUDPM-17.1-2,11/4/21,1/28/22,RA0607,82,2,0,0,0,0,1,0,0,0,"5'3""",216 lbs,38.26,62,123/46,2.5 years,1,"c/o bilateral knee swelling,  bilateral leg pain, worse since returning from Mexico one day ago  ",3,1,3,3,3,2,2,2,2,2,2,2,1,her daughter,0,0,0,0,0,0,0,1,0,0,0,0,0,,Plavix 75 mg daily   Hydrochlorothiazide 25 mg Daily  Losartan 50 mg Daily  Tylenol 650 mg every 8 hours PRN,NA,0,1,0,0,,"1) bilateral knees, bilateral legs  pain when walking, pain is continuous when walking/moving",0,0,1,0,0,PT,participated in PT - Jan 2020,"NSAIDs, Tylenol, Cortisone shots",Tylenol and cortisone shots,0,0,0,0,0,0,walking with decreased pain,"daughter is care giver, aids in all ADLs, medication administration, accompanying patient to appointments etc",per patient and caregiver report,"What is best  pharm option for pain management? In past she has been prescribed nabumetone and celecoxib, by other providers. Should NSAIDS be prescribed long term (she is on plavix)? What is best non pharm therapy?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
18,,1/24/22 13:26,OUDPM-18.1-2,1/19/22,2/4/22,JL0918,66,1,0,0,0,0,1,0,0,0,5'7,144,22.6,74,132/88,seen only for 1 time encounter,0,"OSH does visits called Welcome visits. This is for a person to come in, meet the provider discuss any medical concerns before patient decides to establish care.   Pt was seen 1/19/21. He did not bring any of his medication except for Alprazolam 2mg which he states he takes 1/2 tab BID. Given access to local hospitals, per the portal system- was able to obtain recs that pt presented to the ED in Dec and Jan for medical refills. In which he was given 30 day supply.  He also feel that morning and wanted a prescription ""for the only thing that works is Norco""",1,1,1,1,1,1,1,1,1,1,1,1,2,,0,0,0,1,0,0,0,0,0,0,0,0,0,,alprazolam 2mg- reports he takes 1/2 tab QD.,unknown,1,0,0,0,,"at his visit, pt casually mentioned that he fell at home-unwitnessed. Denies head injury or LOC. Pt states he has sciatica-and the only thing that works for him is Norco",0,0,0,0,1,pain management  PT  chiropractor  ,"none, pt refused ",NSAID  gabapentin  tylenol ,pt accepted a rx for Naproxen 550mg BID,0,0,0,0,0,0,pt will trial PT  and f/u with pain specialist,unknown,referred pt to MSW to assist with 1-scheduling the appts  2-f/u with the patient 2 days before the appt and the day before  and the day off to assure compliance  ,"as far as the xanax goes-i checked IL PMP and it seemed as if that his PCP, is weaning off the medication-but with his recent insurance he is unable to go. To avoid withdrawn, I did give him a 20 day supply- and was strict in telling him I will not prescribe this medications again- I also rx'ed  hydroxyzine. We agreed he will try to wean off-Urine tox showed (+) xanax only. any other suggestions",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
19,,1/26/22 0:45,OUDPM-19.1-2,10/15/20,1/28/22,CJ00717,65,1,0,0,0,1,0,0,0,1,6',213,,83,118/73,1 month - then followed by other providers,0,"bilateral foot pain, Lower extremity pain, ",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,amitriptyline 10 mg daily  Atorvastatin 40 mg daily  Losartan 50 mg daily  aspirin 81 mg daily  ,none completed,0,1,0,0,,"intermittently ""excruciating"" pain, multiple joints, worse in legs, terrible cramping.  Headache, chronic lower back pain",0,0,0,0,1,Physical Therapy  Referred to podiatry and to ortho  Testing: vascular: venous and arterial doppler.  Autoimmune   ,Physical Therapy,tylenol  amytriptaline 10 mg daily,tylenol / Ibuprofen as needed  amytriptaline 10 mg daily,0,0,0,0,0,0,improved pain,"Lives alone, son and  family supportive, but not active in care","Follow up to discuss in 6 weeks.  However, no follow-up with this provider.     ",Should I have attempted to treat with gabapentin? ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
20,,1/30/22 16:23,OUDPM-20.1-2,6/23/20,2/4/22,MB0521 ,66,1,0,0,0,0,1,0,0,1,"5'1""",134lb,25,112,137/88,3 yrs,1,"Pain f/u, Anxiety f/u, Refill of medications (long-term benzo & opioid rx)",1,1,1,1,1,1,3,3,1,3,1,1,0,,1,0,0,1,0,0,0,0,0,0,0,0,0,,acetaminophen 325mg 2 tabs QID prn  alprazolam 1mg BID  hydrocodone-acetaminophen 5-325mg 1 tab QID prn (takes scheduled)   lisinopril 10mg QD   paroxetine 20mg QD, +benzos  +opioids,0,1,0,0,,"Generalized; worst in bilateral shoulders, neck & thoracic spine and paraspinals (has ankylosing spondylitis w/severe kyphosis and severed decreased cervical ROM).  achy, 5-8/10. Constant, worse with poor sleep or lots of activity.",0,1,0,1,0,"topicals  acupuncture, TENS  OMT  PT  meditation, pain psych  referral to Rheum for AS","topicals - declines  acupuncture, TENS - declines  OMT - no access  PT - states anxiety prevents him from attending appt  meditation, pain psych - declines  referral to Rheum for AS - lack of transportation (40+ min drive)","NSAIDS (avoiding as pt has HTN, CKD3 and untreated DM)",,1,1,0,1,1,0,,"extremely limited social support (lives alone, divorced, 2 kids live >2h away)",monthly visits w/PCP for reassessment," - With two sedating agents, how to accomplish slow wean (given significant anxiety about uncontrolled symptoms if dose is decreased)?  - How to frame nonpharmacologic options to change readiness for patient to try them, and how to assist with attending specialist visits?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
21,,2/2/22 0:17,OUDPM-21.1-2,12/21/21,2/4/22,RB0402,67,1,0,0,0,0,1,0,0,1,170.18,49.8,17.2,80,105/68,about 20 years,1,"follow up T2DM, Lung Ca, Esophageal Cancer, COPD, Cigarette smoking, Esophagogastric pullup anastomosis   stricture, Dorsalgia   with  T7,T8&T9 osteoporotic compressions SP vertebroplasty to each of these level",3,1,1,1,1,3,3,3,3,1,1,1,1,wife,0,0,0,0,0,0,0,1,0,0,0,0,1,anxiety reactive,"Albuterol nebs 2.5 mg/3ml q4-6 h prn, Aa 81 mg daily, atorvastatin 10 mg at hs, Boost high protein 16 oz bid, Carvedilol 3.125 mg 1/2 po bid, Glucose 4mg chew 4 for hypoglycemia, Vitamin D#  50mcg daily, Flomax 0.4 mg daily, Furosemide 40 mg daily, Glucagon 1 mg injection prn  hypoglycemia not responding to glucose tabs, Losartan 50 mg daily, Metoclopramide 10 mg ac tid,  NTG 0.4 mg SL q 5 min for chest pain,dyspnea or indigestion if 3 are needed for any episode call 911 & go to er, Novolog o.7 u/hr and 2 u bolus with meals thru insulin pump, Plavix 75 mg daily, Proair 1or2 puffs q 4-6 h prn, Proscar 5 mg daily, spironolactone 25 mg daily, Carafate 1 gram/10 ml 10 ml ac TID and HS, Symbicort 160-4.5 mcg  2 puffs bid, Torsemide 20 mg daily, Acetaminophen 500 mg 2 po qid prn",9/13/18 UDS only + for tricyclic antidepressant,0,1,0,0,,Pain is over upper back It is aching and continuous worse with movement relief with acetaminophen,1,0,0,0,0,VertebroplastyT7 T8 & T9,Vertebroplasty T7 T8 & T9,"Tylenol ES now previously Lyrica 50mg, baclofen,  and before vertebroplasties were completed  oxycodone 10 mg",as above,0,1,1,1,1,0,to increase function to gain the best quality of life possible with reducing pain safely A Controlled Substance agreement and Informed Consent for controled pain meds  are signed and on chart,His wife is supportive and both this pt and his wife a retired,The patient does not now need controlled pain med but should he in the future need that It will be monitored wit pretreatment controlled substance agreemenr and   an infrmed consent signed a pretreatment UDS and periodic  uds   revew of state  prescription monitoring  with each  controlled pain prescription, what suggestions to prevent  injuries is prevent falls or other aggravating  factors that may lead to loss of pain control Recommendations to avoid worsening of osteoporosis in this person who already needs so many meds and  suggestions to accomplish cessation of smoking,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
22,,2/16/22 16:38,OUDPM-22.1-2,2/4/22,2/18/22,MA0915,58,2,0,0,0,0,0,0,1,0,"5""15",178,32.9,94,142/104,6 months ,0,"She has severe depression with severe anxiety/panic.  She had issues  related to housing, income & waiting for SSI.  She recently moved but reports high stress in her life.    She has many other health issues like Fibromyalgia, Hypertensive Dx, Prediabetes, Poor vision (she can't see from her left eye and it's protruding outward, per her report) & Lymphedema.    She is often in tears from pain from the tissue and all over her body.  ",3,3,3,3,3,3,3,3,3,3,3,3,0,,1,0,0,1,0,1,0,1,0,0,0,0,0,,"None, she doesn't take them.    Ibuprofen 800mg every 8 hrs as needed",None ,1,1,0,0,,"She has pain all over her body, per her report.  She can't see out of her left eye & it's sticking outward.  She reports pain on her neck, back and bones due to Chronic Arthritis, Lymphedema (tissue pain) & Fibromyalgia.  Reports having Chronic Arthritis & Lymphedema-tissue swelling & often in tears or can't get out of bed.",0,0,1,0,1,"Stress Management,   Depression Management  Physical Therapy.  ","Stress management and   depression management.-not taking meds though, consistently.  Duloxetine 30mg daily ",Ibuprofen 800mg. ,Unsure ,0,0,0,0,0,0,She wants to get back on any meds to reduce amount of time in bed.      ,"Her husband reminds her to take her meds and she says if it wasn't for him, she would not take meds.  ",She has biweekly behavioral health visits to help her stay focused.  No real way to measure them for now.  ,What are some things she can do to reduce tissue pain?  Any other suggestions for her overall pain reduction in regards to meds or nonpharmacological therapies?  ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
23,,2/9/22 18:11,OUDPM-23.1-2,5/26/21,2/11/22,RD112,65,1,0,0,0,0,1,0,0,1,"5'6""",140,22.3,60,156/76,1 year,1,"Cirrhosis of the liver, Pt stated he never drank, d/t heroin, no family hx of etoh abuse  Symptoms/Nature of problem: Dr. Kuehn referred,    When did the problem start? Describe the course. (Current and past psych history, if applicable)  I have always been honest with drug use, I have already worked for my money, I have cirrhosis of the liver, but I didn't drink. Pt stated he doens't have any cravings, but would want to smoke a joint.        Heroin-was using daily, June is two years sober    Previously on methadone program, went from 95mg to 60mg, in 1 week to detox, then wanted to get off. PT went to the Methadone program-Nexum on Lake Street.  PT stated he smoked marijuana that was laced. ",1,1,1,1,1,1,1,1,1,1,1,1,1,Sister,1,0,0,1,0,0,0,1,0,0,0,0,0,,acetaminophen 500 mg tablet  TAKE 2 CAPSULES BY MOUTH EVERY 6 HOURS AS NEEDED     buprenorphine 8 mg-naloxone 2 mg sublingual film  PLACE ONE FLIM UNDER THE TONGUE TWICE DAILY     Eliquis 2.5 mg tablet  TAKE 1 TABLET BY MOUTH EVERY 12 HOURS AS DIRECTED     levothyroxine 100 mcg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY     lisinopriL 10 mg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY     Narcan 4 mg/actuation nasal spray  USE 1 SPRAY NASALLY AS NEEDED     ProAir HFA 90 mcg/actuation aerosol inhaler  Inhale 2 puffs every 4 hours by inhalation route.     rosuvastatin 20 mg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY,"1/31/2022  fentanyl	  positive  abnormal  fentanyl	  4.0  high  norfentanyl	  9.0  high  buprenorphine	  positive  abnormal  buprenorphine	  149  high  norbuprenorphine	  1143  high  naloxone	  14  high  marijuana metabolite	  positive  abnormal  marijuana metabolite	  255  high",0,1,1,0,,Leg pain affecting the quality of his sleep. PT living with his sister. Pt had procedure last year on his legs that helped somewhat with improving functioning. ,0,0,0,0,1,Behavior activation for exercise/movement as tolerated. Referral for substance abuse counseling and/or groups. ,"Pt was active while living with his sister, doing chores and yard work.     Behavior activation for physical activity, identifying triggers/situations r/t substance use and relapse. ",acetaminophen 500 mg tablet  TAKE 2 CAPSULES BY MOUTH EVERY 6 HOURS AS NEEDED     buprenorphine 8 mg-naloxone 2 mg sublingual film  PLACE ONE FLIM UNDER THE TONGUE TWICE DAILY     Eliquis 2.5 mg tablet  TAKE 1 TABLET BY MOUTH EVERY 12 HOURS AS DIRECTED     levothyroxine 100 mcg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY     lisinopriL 10 mg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY     Narcan 4 mg/actuation nasal spray  USE 1 SPRAY NASALLY AS NEEDED     ProAir HFA 90 mcg/actuation aerosol inhaler  Inhale 2 puffs every 4 hours by inhalation route.     rosuvastatin 20 mg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY,acetaminophen 500 mg tablet  TAKE 2 CAPSULES BY MOUTH EVERY 6 HOURS AS NEEDED     buprenorphine 8 mg-naloxone 2 mg sublingual film  PLACE ONE FLIM UNDER THE TONGUE TWICE DAILY     Eliquis 2.5 mg tablet  TAKE 1 TABLET BY MOUTH EVERY 12 HOURS AS DIRECTED     levothyroxine 100 mcg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY     lisinopriL 10 mg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY     Narcan 4 mg/actuation nasal spray  USE 1 SPRAY NASALLY AS NEEDED     ProAir HFA 90 mcg/actuation aerosol inhaler  Inhale 2 puffs every 4 hours by inhalation route.     rosuvastatin 20 mg tablet  TAKE 1 TABLET BY MOUTH EVERY DAY,1,1,1,1,0,0,"Maintain mobility by engaging in household chores and/or work. IF PT was to get a dog, to be able to go for walks. ",Pt's sister is active and supportive of Pt.     Pt had moved out of his sister's house and had obtained his own apartment and was working. ,Weekly appointments through MAT,"Re-engagement in behavioral health services. Pt had discontinued after he moved out and had started working. He did not respond to outreach attempts for behavioral health, but he is engaged in MAT.",0,1,0,1,0,1,0,0,1,0,0,Young Adult,1) Engage in treatment in order to stay at sister's home.    2) To find a relationship for companionship and/or romantic relationship.,1,0,0,1,1,0,0,0,1,1,0,0,0,0,,Unknown,1,0,0,0,0,0,0,0,0,0,0,1,0,1,0,0,0,1,0,0,,0,1,1,0,0,0,0,0,0,,PHQ9=2  GAD7=1,1,0,0,buprenorphine 8 mg-naloxone 2 mg sublingual film,1,0,0,0,0,Access to services and social supports are limited. ,1,1,1,1,0,0,0,1,1,0,0,0,0,1,0,0,0,0,0,0,0,0,"How to engage Pt when he has met with BH and says that everything is always ""fine"" and denies use, stated that any positive drug tests were false or marijuana was laced. He had dropped out of treatment and I am trying to see what may be helpful for him at his next appointment judging his stage of change. ",2
24,,2/14/22 15:44,OUDPM-24.1-2,,2/18/22,AH0723,83,1,0,0,0,1,0,0,0,1,,,,,,,1,"PAD, bilateral foot pain  Also saw him for malnutrition in setting of SCC  Has hx COPD, HTN, BPH as well",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,Albuterol q4PRN  Amlodipine 10mg qd  ASA 81mg qd  Atorvastatin 40mg qd  Ensure supplement TID  Tamsulosin 0.4mg qd  Vitamin B complex qd  Zinc 40mg qd    * Does not have prescription for any pain medication. He states he is treating himself with two naproxen twice a day and does not know the dose,,0,1,0,0,,"He has bilateral foot pain and calf cramping with activity and improves with rest. He feels that his pain is greatly improved with naproxen. He does not get relief from Tylenol. These are the only two medications he has tried. On physical exam he has skin peeling and hyperpigmentation of b/l shins and feet. Very faint DP pulses b/l. His gait is abnormal with high knee lifts ""the way PT showed me how to do it."" However strength exam normal.",1,1,0,0,0,Exercise was my main recommendation. Smoking cessation discussed as well,"This was our first apt, I will f/u on this",Topical lidocaine gel and improved PAD regimen to start atorva/ASA,Will f/u next visit,0,0,0,0,0,0,We discussed continuing active lifestyle (he would like to complete a home renovation project),Patient lives alone and is quite independent. I need to explore this further.,Continued outpatient follow up.,"I would like to develop an alternative plan to offer the patient to trial to help him come off the naproxen. I'm interested in what pharmacologic agents people have found the most success with for peripheral artery disease in addition to non-pharm. Does anyone use cilostazol? There are some topical recommendations that require a compounding pharmacy, does anyone ever prescribe topicals that need to be prepared by a compounding pharmacy? I probably need to add on a neuropathic agent too, wondering if you would make multiple changes at once or one at a time?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
25,,2/22/22 17:36,OUDPM-25.1-2,12/13/21,2/25/22,BB0119,74,2,0,0,0,0,1,0,0,1,"60""",160lbs,31.2,89,130/64,Since 12/23/21,0,Dental extractions with sedation,3,1,3,3,1,1,1,3,3,1,1,1,1,Husband,0,0,0,0,0,0,0,1,0,0,0,0,1,anxiety/stress,Norco 5/325 1 tid  acetaminophen prn  Lidocaine patch 5% qd  paroxetine 40mg qam  Saphris 5mg qhs  alprazolam ER 3mg qd prn  bupropion 150mg qd  Lyrica 50 mg bid  Letrozole 2.5mg qd  Carvedilol 6.25mg bid  Novolog 15u tid before meal  Glulisine 36u bid before meal  Lasix 20mg qd  Atorvastatin 40mg  Vit D  Calcium    ,,1,1,0,0,,Patient has neurostimulator placed in 2020 for R sciatica.  Has bilateral knee replacements (2002 & 2004)  Breast CA lumpectomy and lymph node dissection.  RT completed 12/3/21.  Osteoathritis,0,0,0,0,0,Photobiomodulation,Photobiomodulation,Norco,Norco,0,1,0,0,0,0,,Husband cares for patient,,"Most of the patients that I treat for pain have acute pain, such as post-op or infection.  This patient has chronic pain and multiple medical issues.  She can't take ibuprofen.  So I'm left with acetaminophen and Norco.    1. What recs are there regarding acute pain management for this patient?  I was concerned that she would require higher doses of Norco post-op due to tolerance and that can be a problem considering her age and polypharmacy.  What other strategies can I use for a patient like this?  2. If this patient had a history of OUD and I couldn't prescribe opioids what is left to do?  In the past I've had to rely on acetaminophen.",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
26,,2/24/22 14:51,OUDPM-26.1-2,1/3/20,2/25/22,DT1940,81,1,0,0,0,0,1,0,0,1,5'11,150,20.9,69,123/69,2 years ,0,"chronic pain, opioid use dependence ",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Pantoprazole 40mg QAM, Metoprolol Succinate ER 50mg QAM, Spiriva with Handihaler 18mcg 1 puff, Suboxone 8mg/2mg one film BID, Vitamin D 5000iu, Metformin 500mg BID ",neg ,0,1,1,0,,"Pain in lower back and legs, throbbing, pain is constant, cold temps make the pain worse, movement makes it worse ",0,0,0,0,1,None ,None ,Suboxone ,Suboxone 8mg/2mg one film SL BID ,1,1,0,0,0,0,The goal for the patient was to walk again and resume his activities of daily living,"The son called me and said I was not allowed to give his Dad opioids because he was a ""drug addict""     Social support including multiple neighbors asking me to help him because they were scared.  Neighbors were asked to report any unusual behaviors.","UDS, Vitals, Oxygen, ILPMP  ",This patient still believes I'm a drug dealer. He will only pay me in cash.  He makes comments like this is between us.  He won't get his medication at Walgreens he only gets my medication at CVS.  After two years I just go along with it.  His three month supply always last six months.  He is doing phenomenal.  I wish he understood the medication is not illegal.  ,1,1,0,0,0,0,1,1,0,1,1,75,To walk again,1,0,0,0,0,0,0,0,0,1,0,0,0,0,,smokes cigs 1 ppd ,1,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,,,1,0,0,Suboxone 8mg/ 2mg 1 slice of a film every 2-3 hours.  Doesn't use more than one film a day. ,1,0,0,0,0,stigma ,1,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,See above- he thinks I'm a drug dealer. ,2
27,,3/14/22 15:29,OUDPM-27.1-3,3/8/22,3/18/22,AL0626,76,1,0,0,0,1,0,0,0,1,"5'10""",169 lb ,24.25,88,140/74,1.5 years,1,"Chronic back pain, chronic opioid use ",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,, - MS CONTIN 15 mg daily   - Norco 10-325  2 tabs 3 times daily   - pantoprazole 40 mg BID  - naloxegel 12.5 mg daily   - metformin 500 mg   - lisinopril 10 mg daily   - HCTZ 25 mg daily   - Atorvastatin 40 mg daily   - advair 2 puff BID  - albuterol as needed   - Narcan spray as needed   - ferrous sulfate 220 mg daily   ,9/18/21   positive for cocaine and opiate ,0,1,1,0,,"The pain is in the lower back and radiates to the right leg. The pain is 7-8/10, constant.   It is worse with standing and walking. ",1,1,0,0,0," - Ice, heat   - Physical therapy ","Ice, heath and Physical therapy - did not help ", - Tylenol   - NSAIDs  - Gabapentin   - Intervention injection   - spinal cord stimulator with epidural electrode placement  , - NSAIDs >> developed gastric ulcer  - Gabapentin >> pt states did not help much  - Intervention injection >> did not help much   - spinal cord stimulator with epidural electrode placement  >> was helpful with a trial but did not work much later,1,1,1,1,1,1,"To have the patient take the lowest possible dose of mediation that is reasonably effective in managing his pain and improving his function, and when possible, have it tapered and eventually discontinued. ",NA,The patient follows up monthly for pain evaluation and try to taper the dose and continue with non-opioid management ,"1.  I started to taper his opioids from MS CONTIN 60 mg BID and Norco 20 mg TID and now down to MS CONTIN 15 mg daily with Norco. I plan to stop MS CONTIN next month and start to taper the Norco. In the past, we discussed this and it seemed that he did not feel that he would be able to taper off Norco. Any suggestion regarding this and is it possible that we will eventually stop his opioid in the future? He is already treated with a pain clinic with epidural electrode placement but he mentioned it did not work much.   - any other options/suggestion for his pain management?",1,0,1,1,0,0,0,0,0,0,1,72,side effect from opioid: constipation ,1,0,0,0,0,0,0,0,0,0,0,0,0,0,,MS CONTIN 15 mg daily   Norco 10-325 2 tabs TID ,1,0,0,0,0,0,0,0,0,0,1,0,0,1,0,0,0,0,0,1, - Patient tried Detox program but left before completing the program (states he did not like the facility)  - He was started on suboxone program but did not like it then stopped using it. ,1,0,0,0,0,0,0,0,0,,,0,0,0,,1,0,1,0,0,NA,0,0,1,0,0,0,1,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,The patient currently is not interested in a detox or suboxone program. Any recommendations? ,2
28,,3/17/22 14:09,OUDPM-28.1-3,12/7/21,3/18/22,FM0149,73,2,0,0,0,1,0,0,0,1,"5'3""",215 lbs,38.09,90,128/78,3,1,Patient has DJD and deformity of right knee that requires right knee arthroplasty. Pain is severe however patient does not want surgery as recommended by Orthopedist.,1,1,1,1,1,3,3,3,1,1,1,1,1,Granddaughter for support,0,0,0,0,0,0,0,0,0,0,0,0,1,mild anxiety,"NIFEdipine (PROCARDIA XL) 60 mg 24 hr tablet daily,  - simvastatin (ZOCOR) 20 mg tablet daily;   - pantoprazole (PROTONIX) 20 mg tablet daily;   - hydroCHLOROthiazide (HYDRODIURIL) 25 mg tablet daily;   - hydrALAZINE (APRESOLINE) 25 mg tablet-four times daily;   - docusate sodium (STOOL SOFTENER) 100 mg capsule -2 times as needed daily;    - carvediloL (COREG) 6.25 mg tablet-twice daily;    - baclofen (LIORESAL) 10 mg tablet-3 times as needed daily;   - enalapril (VASOTEC) 20 mg tablet daily ",N/A,0,1,0,0,,"Pain in right knee, described as an ache, rated 8/10, intermittent,  mostly with weight bearing and getting up from a sitting position, does not radiate, impairs ability to ambulate",1,0,1,0,0,"warm/cold compress, massage, weight loss, physical therapy, surgery","warm/cold compress, massage","Muscle relaxant, OTC analgesics, NSAIDs, antidepressants","Muscle relaxant, OTC analgesics",0,0,0,0,0,0, -Reduce patient's level of pain  -Decrease effect of pain on ability to perform daily activities  -Decrease effect of pain on ability to enjoy life, -To act support system in preparing healthier meals to facilitate weight loss  -To act as emotional support system,Through patient's rating of pain during visits and reported quality of life,Patient thinks she will do well on NSAIDs however history of gastric bleeding makes writer reluctant to attempt use NSAIDs. Patient wants to continue muscle relaxant for pain however increases risks for falls.,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
29,,3/21/22 12:53,OUDPM-29.1-3,3/8/22,3/25/22,RL0424,65,1,0,0,0,1,0,0,0,1,"5' 11""",203 lb,28,70,126/69,1 year,1,"History of HTN, BPH, glaucoma with vision impairment with chronic neck pain (s/p C3-6 laminectomy and fusion) and low back pain. ",1,1,1,1,1,3,3,3,2,3,1,1,0,,0,1,0,1,0,0,0,0,0,0,0,0,0,,"amlodipine 10  losartan-hydrochlorothiazide 100-25  tamsulosin 0.4 mg  gabapentin 300 am, 300 afternoon, 600 evening  baclofen 10/5/5  naproxen as needed  ",,0,1,0,0,,"Pain located around his neck and his bilateral low back, with recent new symptoms of burning pain in his legs. ",1,1,0,1,0,"Was already seeing pain medicine. Had been referred to physical therapy (had issues with insurance, unstable housing), BHC",received trigger point injections from pain medicine.   Seeing BHC for anxiety.,," -Baclofen - has been on for a long time   -switched from pregabalin to gabapentin due to insurance  naproxen   topicals - lidocaine, diclofenac  -has history of being on amitriptyline ",0,0,0,0,0,0,,Stays at a supportive living community for adults who are blind,,"Has history of gastritis, trying to limit NSAID use. Other therapies to help with limiting NSAIDs?  I worry about polypharmacy with his vision impairment, but gapabentin and baclofen seem to be helping his pain. ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
30,,3/24/22 8:54,OUDPM-30.1-3,3/23/22,3/25/22,HS1204,57,1,0,0,0,1,0,0,0,1,68 inches,162 lbs,24.66,98,158/82,This was our fist visit - Access Patient since March 2020,0,"""Check up""  Hypertension - ""my blood pressure's been going up and up""  Chronic pain of  R knee  Acute pain of L shoulder  OUD",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,Methadone 80mg QD,n/a,1,1,1,0,,"Location - chronic - R knee (since military service, d/c in 1985, gradually worsening since 2000). Acute - L shoulder after MVA 3w ago.   Quality - R knee - describes as aching, cracking with ambulation, worse with activity, improved with rest, varies from 4-10/10. L shoulder - describes as soreness, constant, rates about 5/10.   Influencing factors - h/o injury to R knee, military service (military boots), walking is main mode of transportation.  Associated manifestations - poor sleep, impaired mobility and transportation (ie around neighborhood, to/from methadone clinic and other apptointments)",1,0,0,0,0,Ace bandage wrapping  Ice/Heat  Capsaicin  Topical Analgesics  PT  ,Continue wrapping (bracing)  Continue ice after active days  Added Capsaicin  Referred to PT - potential barrier is follow up,NSAIDs  Tylenol  (Considered current methadone and heroin use),"Combination of NSAIDs and Tylenol, scheduled ",0,0,0,0,0,0,Improved ambulation,N/a,Follow up visits with preferred provider,Balancing use of NSAIDs with elevated BP and OUD  Treating both chronic and acute pain,0,1,1,1,0,0,0,0,0,0,0,"unknown - heroin use x40y, methadone use x2y",,0,1,0,1,0,1,0,0,1,0,0,0,0,0,,"Heroin - snorting $20, several times weekly, not daily  Alcohol - unable to quantify  Cocaine - occasional  MJ - daily",0,0,1,0,0,0,0,0,0,0,0,0,1,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,1,0,80mg QD,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,1,"Interviewing - asking difficult questions, obtaining useful information when patient is distracted, inebriated, unable to discuss in a straightforward manner",2
31,,3/24/22 13:15,OUDPM-31.1-3,3/4/22,3/25/22,SW0727,61,2,0,0,0,1,0,0,0,1,5'7'',125 lb,19.7,64,153/80 repeat 138/81,Oct-21,0,"Patient is a 61 years old female who is currently unemployed, her past medical condition is significant for COPD, HTN, anxiety, depression, opiod abuse. Patient is here today for bilateral hand pain. She also would like medication refill and discuss her CT chest results .   Patient with bilateral hand pain that has been ongoing for the past 2 years. Patient feels that pain has worsen during the past few months",1,1,1,1,1,1,1,1,1,1,1,1,0,,1,0,0,1,0,0,0,1,0,0,0,0,0,," - lisinopriL (PRINIVIL,ZESTRIL) 20 mg tablet TAKE 1 TABLET BY MOUTH DAILY	  - amLODIPine (NORVASC) 10 mg tablet  TAKE 1 TABLET BY MOUTH DAILY  -Diclofenac Sodium 1 % Gel 100 g Apply 1 Dose topically 4 times daily. - Topical (Top)  - ipratropium (ATROVENT HFA) 17 mcg/actuation inhaler	1 Inhaler Inhale 1 puff into the lungs 3 times daily   - albuterol (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation inhaler	18 g INHALE 2 PUFFS BY MOUTH EVERY 4 TO 6 HOURS AS NEEDED FOR SHORTNESS OF BREATH OR WHEEZING	  - NARCAN 4 mg/actuation Spry			 USE 1 SPRAY NASALLY ONCE AS NEEDED FOR OVERDOSE FOR UP TO 1 DOSE	            	        ","2017 to start buprenorphine MAT progam.  - Opiate Screen, Urine	Cutoff=300 ng/mL	Positive   Comment: Opiate test includes Codeine, Morphine, Hydromorphone, Hydrocodone.  - Fentanyl, Ur Cutoff=2000 pg/mL Positive       ",0,1,1,0,,"bilateral hand pain and Right knee pain   achy, daily intermittent, ",0,0,1,0,0,Heat therapy   hand wax  hand ball,heat therapy ,Ibuprofen  diclofenac gel ,ibuprofen   diclofenac ,0,0,0,0,0,0,Decrease time that patient experiences pain during the day. ,No family and social support .,Patient to verbalize if she has experience longer period of being pain free during the day. ,how can I better help this patient achieving longer period being pain free throughout the day. ,0,1,0,0,1,1,1,0,1,0,1,,"Patient would like to stop using heroin, but doesn't want to use MAT.   Patient reports about 8 months ago she tried being hospitalized to stop but could not follow through with the program. ",0,1,0,0,0,0,0,0,0,0,0,0,0,0,,Using $10/day. $20 sometimes. Snort. Doesn't even get her high any more. Just makes her feel normal. Has withdrawal if she doesn't use.  Using 3-4 bags/day,0,0,1,0,0,0,0,0,0,0,1,0,0,1,0,0,0,0,0,0,,1,0,0,0,0,0,0,0,0,,,0,0,0,,1,0,0,0,0,,0,1,0,0,0,0,0,0,0,0,0,1,0,0,0,0,0,0,0,0,0,0,If a patient is interested in quitting but not interested in MAT what other options are available for this patient. ,2
32,,3/28/22 19:18,OUDPM-32.1-3,3/24/22,4/1/22,DB1223,68,2,0,0,0,1,0,0,0,1,5' 1'' ,104 lb,20,78,136/70,9 months,1,Medication refills for chronic pain and other chronic conditions. ,1,1,1,1,1,1,1,1,3,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Nifedipine 90 mg  Losartan 25 mg   Advair BID, albuterol prn   Gabapentin 600 mg BID   Norco 10/325 mg PRN typically once a day   Calcium 500 + D daily   bisacodyl prn   ",Opiates positive ,0,1,0,0,," - Chronic low back pain with radiculopathy, 8/10 aching/burning, worse after activity, impairs ADLs and IADLs  - Chronic right foot pain s/p GSW, 5/10 up to 10/10 sharp pain after being on feet",1,1,0,0,0,"PT, podiatry referral, Behavioral health counseling, foot baths/soaks "," - PT trial for 6 weeks worsened back pain   - Orthotics from podiatry helping with the foot pain   - Soaking foot in the tub providing temporary relief.   - Tried one BHC visit but prefers to keep her life ""private"" ", - Diclofenac gel   - Lidocaine patches   - Gabapentin  - Norco (pt came to me on 2 a day for about 4 years hoping to wean down)   - Pain clinic for injections ,"Patient is taking gabapentin 600 mg TID, Norco 10/325 PRN typically 1 pill a day.     Diclofenac gel and lidocaine patches caused skin irritation.     Interlaminar lumbar epidural steroid injection (LESI) from pain med complicated by central spinal stenosis at recommended injection site (L4), did not provide relief.     Of note, NSAIDs make her stomach upset and tylenol does not provide relief. ",0,1,0,1,1,1, - To maintain her functionality and independence with ADLs and IADLs.   - To wean off norco (patient's goal). ,"Her family and social circle rely on her; she watches kids, cooks food for other families. Discussed setting boundaries. ","Monthly follow up visits, more frequent telehealth visits as needed. ","Patient is hoping to wean off norco, but it has been a challenge to find alternate medications that provide relief and allow her to maintain her functionality. Financial strain is a consideration as well. Does anyone have other suggestions for this patient? Thanks! ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
33,,3/30/22 17:09,OUDPM-33.1-3,3/24/22,4/1/22,LE0320,91,2,0,0,0,1,0,0,0,1,"5' 7""",195 lb,30.54,73,136/64,Jan-21,1,"Primary osteoarthritis of multiple joints, normocytic anemia, history of hilar adenopathy",3,1,3,3,2,2,2,2,2,2,2,2,1,Son,0,0,0,0,0,0,0,0,0,0,0,0,0,,"Tylenol#3 1 tab TID PRN, Meloxicam 7.5mg nightly, furosemide 40mg every 48 hours, pregabalin 150mg nightly, atorvastatin 40mg nightly, triamcinolone 0.1% ointment PRN, calcium with vitamin D 1 tab daily",none,0,1,0,0,,"Hx of Bilateral knee pain (post knee replacement years ago)  C/o right knee and right hip pain, unable to describe, sometimes radiates down from hip.   difficulty  bending.  severe pain 7/10 at least twice a week, when pain is controlled it is 2-3/10. not worse with position. rubbing alcohol on it makes it better. season/time of day has no effect uses cane or walker at home for ambulation but for prolonged walking uses wheelchair. no numbness. no recent trauma.  ",1,1,0,0,0,"physical therapy/exercise, heat & cold",home physical therapy completed in 2021. still does leg exercises at home.  OTC rubbing alcohol,"tylenol, gabapentin, pregabalin, tylenol 3, ibuprofen, naproxen, meloxicam",pregabalin  meloxicam  tylenol 3,0,1,0,1,0,0,"walking to bathroom, kitchen, inside the house without much pain. goal pain is 3/10",has good support of her son who has lived with her for years. he is able to tell what are the bad days and assist with ambulation or prn pain meds on bad days or when pain is 7/10 or above,"PRN medication usage, collateral history","How else can I monitor drug use? Son is good caregiver/historian, gives tylenol 3 every other day only once a day PRN. Since pt is poor historian herself, how can I de-esclatae daily nsaid use (like what parameters)? Other than educating caregiver on side effects, what other discussion should we have? Any other thoughts about her medication list?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
34,,4/4/22 17:09,OUDPM-34.1-3,4/4/22,4/8/22,PM0844,77,2,0,0,0,0,1,0,0,1,5'9,214,31.6,58,120/81,Provider in orientation,0,"Chronic Hep C: (workup) Liver US, Hep Panel, Fibrosure, Genotype  HCV Ab: Reactive  HCV 1740000  wellness exam, patient has chronic Hepatitis C, and HTN with CKD Stage 3B  Doing a workup for Hep C and patient have to get a Liver Ultrasound   HCV 1740000  ALT 30    Kidney Function  Crea 1.5   GFR 32  ",1,1,1,1,1,1,1,1,1,1,1,1,1,Spouse,0,0,0,0,0,0,0,0,0,0,0,0,0,,duloxetine 60 mg 1 tab po daily   losartan 50 mg take 1 tab po daily  metoprolol 25 1 tab po daily   ,N/A,0,1,0,0,,Lower back pain ,0,0,0,0,1,Relaxation techniques ,Heating pad,Tylenol po,Tylenol po,0,1,0,0,0,0,Massage therapy,Family support,Per visit,Treatment plan for chronic pain  Recommendation for chronic kidney disease  Recommendation for Hep C  ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
35,,4/7/22 5:18,OUDPM-35.1-3,3/17/22,4/8/22,VM0415,72,1,0,0,0,0,1,0,0,0,"5'6""",220,35.5,84,151/75,6 years,1,Pt has had low back pain for several decades that radiates down both legs occasionally. ,1,1,1,1,1,1,1,1,1,1,1,1,0,,1,0,0,0,0,0,0,1,0,0,0,0,0,,"albuterol MDI, atorvastatin 40mg, cetirizine 10mg, chlorthalidone 25mg, cialis 10mg, enalapril 10mg, famotidine 20mg, fluticasone spray, norco 10mg bid, losartan 100mg, meclizine 25mig tid, omeprazole 40mg, paroxetine 30mg, tamsulosin 0.4mg","4/9/2019 - + hydrocodone, hydromorphone",0,1,0,0,,"Low back pain, daily, mild to severe depending on activity and weather, no weakness but has tingling in the legs, no bowel/bladder incontinence",0,1,0,0,0,"His MRI shows mod to severe spinal stenosis L2-5 and mod to severe foraminal stenosis L3-5. His last course of physical therapy was in 2016 - caused him more pain. He did OMT until that provider left in 2017, not interested in establishing with someone new. Had steroid injections in the past that didn't help. Not interested in surgical options.",see above,"cyclobenzaprine, gabapentin, ibuprofen, pregabalin, naproxen, tramadol",see above - unable to tol SE,1,1,1,0,0,1,reduce pain so he ccan remain functional,has adult children in town but wishes to remain independent,patient monitors,Patient is happy and comfortable on current norco dose. How do I encourage him to wean further?,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
36,,4/13/22 9:30,OUDPM-36.1-3,3/21/22,4/15/22,OX0928,93,2,0,0,0,0,1,0,0,1,"4'9""",92 lbs ,19.9,96,188/ 74,2 years ,1,"Patient with chronic leg pains and back pain. she has chronic compression fractures in both T10 and L1. EMG results were abnormal showing peroneal entrapment in fibular head. She is also with multiple vascular problems as noted below -     8/ 2018 - revascularization of R leg with R common iliac artery stent, R common femoral artery endarterectomy  5/ 2019 - R femoral artery endarterectomy with patch angioplasty with thrombectomy of R femoral artery bypass graft; stent of external iliac stenosis, angioplasty of distal stenosis  12/ 2019 - L-R femoral-femoral bypass graft with PTFE, thrombectomy of existing R femoral to popliteal bypass graft  2/ 2022 - Occlusion of R femoral-popliteal bypass, Occlusion of R SFA, tibioperoneal trunk, posterior tibial artery, peroneal artery, Occlusion of L superficial femoral artery, left posterior tibial artery, occluded femoral femoral bypass, R external iliac artery occlusion, greater than 50% stenosis of L external iliac artery, abnormal R and L ABI    Currently she is on hydrocodone 7.5/ 325 mg 4 times a day. Also with anxiety and tremors. Managed on clonazepam 1 mg 2 times a day for these.    Also of note, this patient has poor tolerance to meds. Unable to tolerate BP meds and statins.  recently started pletaal. She could not tolerate because of swelling, stomach pain and nausea. So this was stopped then started pentoxifylline.  She found out that because of her eye problems she can't take this.     She has a lot of GI concerns and these have not resolved. She has known IBS with constipation mainly. She has been advised that her narcotics aggravate these problems. constipation.      Also with anxiety and tremors for which she gets the refills of clonazepam.   ",1,1,1,1,1,1,1,1,2,1,1,1,0,,0,0,0,1,0,0,0,0,0,0,0,0,0,,"Calcium with Vitamin D - 1 tab 2 times daily  Clonazepam 1 mg 2 times daily for anxiety and tremors  Vitamin B12 1,000 mcg - daily   Clotrimazole 2% cream - used as needed  Bentyl 10 mg - 1 tab 3 times a day   Diltiazem 2% - as needed  Trusopt 2% ophthalmic Solution - 1 drop 3 times a day  Vaginal Estrogen - as needed  Pepcid 20 mg - 2 times a day  Hydrocodone 7.5/ 325 mg - 1 tab 4 times a day as needed for pain  Xalatan 0.005% ophthalmic solution  Magnesium 300 mg nightly   Vigamox 0.5% - 1 drop 4 times a day to both eyes  Multivitamin - 1 tab daily  Nitro SL - as needed  Zofran ODT  4 mg - 1 every 8 hrs as needed  Miralax 17 g - once daily as needed  Pred Forte 1% - 1 drop to eye every 6 hrs  Restasis - 1 drop to both eyes 2 times a day  Mylicon 125 mcg - 1 to 2 tabs after meals as needed  Vitamin D 1,000 iu daily  ",No recent UDS but never with any illicit substances,0,1,0,0,,"Leg and Feet pain, persistent, moderate to severe, aggravated by ambulating and moving. ",1,1,0,0,0,"Since I have taken over, none.   Behavioral therapy can be considered. Physical therapy will not completely address all her pain. Discussed concerns regarding safety and medication regimen but patient always states she has been on this regimen for a long time with no issues. ",Injections for back has been tried but unable to repeat as patient is very high risk.   Consults done with specialists - not candidate for procedures at her age anymore.,"Gabapentin, trial of lowering clonazepam,  Lyrica suggested but patient never tried this","Gabapentin - stopped because of diarrhea, abdominal cramping  Did not tolerate benzo at lower dose because tremor got worse and was very anxious.   ",0,1,0,0,1,1,Safety is my main concern.  Functional per patient report but I have concerns. She is never with confusion. I had worked with case management about her in the past and it was suggested to do a cognitive eval. I discussed this with her and she declined. ,One of greatest concerns is lack of social support - she lives with spouse who is also with health concerns so no other person helps her. They have no children. I have never seen friends with her. I have suggested home health to evaluate safety but she declined this previously.,PDMP reviewed regularly.   Difficult to assess home and safety and functionality there as she has declined evaluation in the home.,Any suggestions on how to do this safest for her? ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
37,,4/19/22 22:09,OUDPM-37.1-3,3/30/22,4/22/22,JM0325,69,1,0,0,0,0,1,0,0,1,"6'0""",255 lbs,34.58,96,119/77,8,1,"Chronic pain of left hip, left knee and lower back. ",1,1,3,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Norco 10-325 q6h prn, ibuprofen 600 mg q8h prn, acetaminophen 500 mg, gabapentin 100 mg BID, hctz 12.5 mg daily, lisinopril 10 mg daily, atorvastatin 20 mg daily, tamsulosin 0.4 mg nightly, ",3/30/2022 - positive opiates,0,1,0,0,,"Left hip, left knee and back pain. Achy, 7/10. Left hip and knee are the worst. Back pain radiates into legs. Pain is worse in the AM. Aggravated by damp weather, standing or sitting to long. Associated symptoms include stiffness and swelling of the knee.",1,1,0,0,0,"physical therapy, rest",Rest,"opioids, ibuprofen, acetaminophen, gabapentin, lidoderm and injections","opioids, ibuprofen, acetaminophen, gabapentin, lidoderm and injections",1,1,1,1,1,0,Remain independent and active,Family is supportive. Lives with wife. Has a good relationship with children. Has a grandchild that he wants to be able to play with.,Discuss his mobility at each visit,"I am concerned about his tolerance to norco. He has mentioned a few times over the past 12 months that norco does not always ""last as long"". How do I handle this?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
38,,4/19/22 22:10,OUDPM-38.1-3,,4/22/22,RC0215,71,2,0,0,0,0,1,0,0,1,66.5 in,230 lb,36.78,81,133/73,2-3 months ,1,establishing care with a new provider and hip pain ,1,1,3,1,3,1,1,2,2,1,1,1,1,daughter,1,0,0,1,0,0,0,1,0,0,0,0,1,,"alendronate 70mg weekly  bumex 1mg BID  cyclobenzaprine 10mg qhs  gabapentin 300mg TID  levothyroxine 75mcg daily  venlafaxine 37.5mg  ambien 10mg qhs  losartan 50mg daily  metoprolol succinate 25mg daily  pantoprazole 40mg daily   rosuvastatin 40mg daily   januvia 100mg 1 daily   spironolactone 25mg daily   hydrocodone-acetaminophen 10-325mg q6 prn, though takes scheduled    ",have not done one since establishing care,1,1,0,0,,"this visit was multiple sites: R shoulder and hip pain, sharp, has also endorsed back/neck pain due to vertebral fracture. quantity is ""moderate with flares"", timing is constant and daily,  influencing factors: movement is difficult, has joint pain, history of rotator cuff rupture, did not complete PT  associated manifestations: pt is in a cycle of insomnia/pain",0,1,0,1,0,heat/ice  have started discussing aquatic therapy though pt is resistant  meditation/mindfulness   ,"none so far, pt has difficulty concentrating ",have discussed alternative pain management options,"have not done any tapering so far, could consider increasing venlafaxine, though polypharmacy is a concern ",0,1,0,1,0,0,"more of a review of medications, establishing new goals, I expressed my concern about pain options, we agreed to a pain clinic referral ",daughter is involved though does seem overwhelmed/frustrated with care,pt has monthly visits,"it's a bit overwhelming over all, unsure where to start. ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
39,,4/20/22 19:50,OUDPM-39.1-3,4/16/22,4/22/22,DL1208,66,2,0,0,0,0,1,0,0,1,64 inches,324 lbs,55,101,115/74,8 Years,1,Patient with chronic pain of both knees and chronic pain of both ankles. Presented to clinic for pain management.,1,1,1,1,1,1,1,1,1,1,1,1,0,,1,0,0,0,0,1,0,1,0,0,0,0,0,,"Naproxen 500 mg PO BID PRN pain. Lisinopril 10 mg PO daily. Lispro 10 units subq TID. Basaglar 25 units nightly. Buprenorphine 10 mcg/hour change every 7 days, chlorzoxazone 500 mg PO TID PRN muscle spasms.","Codeine, Morphine, Normorphine, Norcodeine.",0,1,0,0,,"Patient with achy pain in both knees and ankles. Reports pain is worse in the morning and worse after walking more than 1 city block. Less pain is present when at rest, but pain is still present.",1,0,1,0,0,,Weight loss (including bariatric surgery). Women's group for those living with chronic pain. Physical therapy. Heat. Ice. Counseling services. Psychiatry services. ,,"Tramadol, Tylenol #3, Synovisc injections, Steroid injections, Tylenol, Ibuprofen, Mobic, Cymbalta, Effexor. ",1,1,1,1,1,1,Patient would like to increase the distance she can walk without stopping. ,Family is very supportive but suffers from their own serious ailments.,,"Patient is suffering from severe OA in both knees has been advised that she would benefit from BL TKA. However, the orthopedic surgeon will not perform the operation because of her weight. I have tried numerous medications for weight loss (phentermine/topirmate, Victoza, Ozempic, Contrave), sent her to a nutritionist, and a bariatric surgeon. Insulin is new in the past year and prior to starting insulin she had difficulty with weight loss. I know that I can begin a stronger scheduled medication for pain management. However, she finds that when the opioids start to wear off she gets muscle aches/cramps/nausea.  ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
40,,4/24/22 10:36,OUDPM-40.1-3,4/18/22,4/29/22,DC1965,57,1,0,0,0,0,1,0,0,1,6',221 lbs,30,89,122/80,2 months,1,Pt was post ED f/u for DVT RLE and pt reported SUD,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,1,0,1,0,0,0,0,0,0,0,0,0,,"Eliquis 5mg PO Daily, Hydroxyzine 25 mg PO BID,  Amlodipine 5 mg PO Daily, Aripiprazole 5 mg PO Daily, Naloxone 4mg nasal spray",Unknown,0,0,1,0,,,0,0,0,0,0,,,,,0,0,0,0,0,0,,,,,0,1,0,0,1,0,1,0,0,0,0,20 -30 ,Independence,0,1,0,0,0,0,0,0,0,0,0,0,0,0,,unknown,0,0,0,1,0,0,0,0,0,1,1,0,0,0,0,0,0,0,0,1,Relapse failure to comply,0,1,0,0,0,0,0,0,0,,0,0,0,0,,0,1,1,0,0,Set in his ways.,1,1,1,0,1,0,0,0,0,0,0,0,0,0,0,0,0,0,0,1,0,1,"Pt engagement?  Needle program for pt edu?  Groups/ employment/housing beyond shelter religious SUD, ex convicts, ex gang?  ",2
41,,4/25/22 12:47,OUDPM-41.1-3,3/22/22,4/29/22,PE0000,57,2,0,0,0,0,1,0,0,,5'1,88lb,,105,158/95,1 month,0,Urinary Incontinence,1,1,3,3,1,1,1,3,3,1,1,1,1,,1,0,0,0,0,0,0,1,0,0,0,0,0,,Alendronate 100mg weekly  Neurontin 800mg daily  MVI  Myrbetriq 50 once daily  Paxil 40mg daily  Oxycodone 5/325mg four times per day,No in the chart,1,0,0,0,,"Bone pain, chronic all day  Back pain intermittent due to sitting most of the day due to amputation of the LLE from below the knee.  Aggravating factors are Osteogenesis imperfecta",0,1,0,0,0,Physical Therapy,Physical Therapy,Tapering off the Opioid and NSAID  -Referring to Bone specialist,Referred to Bone Specialist,1,0,0,0,0,0, -PT  -Seeing the Bone specialist  -Pain clinic , -Taking her to her appointment has 3 children , -Will follow up with her PCP  -Social work to follow up if she has attended PT and if barrier what kind to help support her such as transportation  -Does she need Home Health,None,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
42,,5/17/22 12:09,OUDPM-42.1-4,3/4/22,5/20/22, CJ  1941,80,2,0,0,0,0,1,0,0,0,"5'3""",193 lbs,34,92,122/60,about 6 months,1,  chronic pain issues. depression,3,3,3,1,1,3,3,3,3,3,3,3,1,lives with daughter,1,0,0,1,0,0,0,1,0,0,0,0,0,,citalopram  metoprolol  lorazepam 2 mg each night, + benzos,0,1,0,1, unable to take off or lower lorazepam, back pain  knee pain  abdominal pain,0,0,1,0,0, Physical therapy   pain management  orthopedic evaluation for thoracic spine fractures  psychiatry, daily walks,Tylenol  citalopram  ,currently   back on lorazepam,0,0,1,1,0,0, stil not wanting to do much ,daughter at a loss to get patient motivated. long suffering ,see both every 2 months ,how can I help her chronic pain without increasing her lack of activity and severe sleepiness,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
43,,5/19/22 18:28,OUDPM-43.1-4,1/7/22,5/20/22,SH0166,56,2,0,0,0,1,0,0,0,1,"5'6""",187 lb,30.2,82,141/80,5 y,1,Knee pain and Cough/COPD,1,1,3,1,1,3,1,3,3,1,1,1,1,Partner,0,0,0,0,0,0,0,0,0,0,0,0,0,,"Tylenol 650 mg tid prn, albuterol prn, norvasc 10 mg daily, symbicort 2 puffs bid, spiriva daily, Pepcid 40 mg daily, Flonase 2 spr daily, duoneb prn, singulair 10 mg qpm, miralax, guaifenesin prn, pataday daily", + cocaine (done in hospital),1,1,1,0,,R knee pain with swelling down to ankle x 4-5 weeks. No injury or overuse. Pain is constant and severe. Patient unable to describe pain 'it hurts'.,0,0,0,0,1,"At the time, she asked for refill on medication that starts with an L that makes her sleepy and makes her pain go away. ",At that visit none. Prescribed Voltaren gel at the next visit though.,She wanted the pill with and L. Prescribed Lodine.,Prescribed Lodine.,0,0,0,0,0,0,Pain relief.,N/A,Pain relief,,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,1,0,1,0,0,1,1,0,0,0,0,,Smokes and drinks on weekend only. 1-2 cig/week and 12 beers over the weekend. Denied cocaine use at previous visits.,1,0,0,1,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,1,PHQ-2,0,0,0,0,,0,0,0,0,0,N/A,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,0,0,Managing severe pain with h/o SUD and severe COPD.,2
44,,5/31/22 22:51,OUDPM-44.1-4,5/23/22,6/3/22,JG0824,61,2,0,0,0,1,0,0,0,2,61 inches,140 pounds,27,92,120/78,KM since 2/17/2020,1,"Post-surgical back pain following T11/T12 microdiscectomy 4/2022 for chronic back pain with recent onset of foot drop, urinary and stool incontinence, and two recent falls with cord compression noted on MRI.  Prior to surgery patient was using heroin along with Norco for pain management.   ",1,1,1,1,1,2,1,3,2,1,1,1,1,"niece, daughter, and son",1,0,0,0,0,0,0,0,0,0,0,0,0,,buprenorphine8/naloxone 2 film SL QID  cyclobenzaprine 5 mg Q 8 PRN  gabapentin 300 mg TID  hydroxyzine HCl 25 QID  naloxone 4 mg/actuation PRN  nicotine 14 mg patch QD  ondansetron HCl 4 mg Q 6 hours  trazodone 50 mg HS,None on chart--will check further before Friday,0,1,1,0,,post-op pain is currently controlled with medications including gabapentin and suboxone.    Prior to surgery patient had bilateral sciatica with radiculopathy.  ,0,0,0,0,1,physical therapy,Patient began post-op physical therapy at Humboldt Park Hospital on 5/20/2022.,,Suboxone was started at Rush while inpatient for spinal surgery.  (Prior to then patient had declined suboxone due to a single poor experience and a preference for methadone.  Patient had once been abstinent for 7 months following methadone treatment.)  ,1,1,1,1,0,0,Goal is total abstinence of narcotics.,Patient admits that there are people around her that use narcotics.,"Patient will be followed by the PCC Chemical Dependency Program, with Dr. KM as PCP.  Is also scheduled for follow-up with neurosurgeon.",,0,0,0,0,0,0,0,0,0,0,1,more than 5 years ago ,,0,1,1,0,0,0,0,0,0,0,0,0,0,0,,"Up to $50/day. Snorting only, never IV.    Was able to reduce heroin use once Norco was prescribed, down to $30/day, then down to $10-20/3 days.  No heroin use since 4/12/22.  ",0,0,1,0,0,0,0,0,0,1,1,0,1,0,0,0,0,0,0,0,,0,1,0,0,0,0,0,0,0,,"Patient never reported a PHQ-9 score high than 2, but has a diagnosis of major depressive disorder.  Has consistently declined a trial of SSRI/SNRI.",1,0,0,1 8mg buprenorphine/ 2mg naloxone film sublingually four times daily.  ,1,0,1,0,0,"Patient was very resistant to suboxone for over 2 years, despite its availability at PCC where she was a patient. She had tried it once and experienced precipitated withdrawal.   She wanted to restart a methadone program.  When a referral was made for her to a methadone program at El Rincon she missed the intake appointment.  Her previous methadone program was at the Women's Treatment Center.  The neurosurgeon was able to get her to start on suboxone post-op.  ",1,1,0,1,0,0,0,1,0,0,0,0,0,0,1,0,0,0,0,0,0,0,"As she recovers from surgery and the Norco is weaned to off, will she have recurrence of precipitated withdrawal on the suboxone.  Will she be able to stay off of heroin given those around her who are still using.",2
45,,6/2/22 19:04,OUDPM-45.1-4,4/8/22,6/3/22,AV0320,61,1,0,0,0,0,0,0,1,0,5ft 4in,178lbs ,30.6,98,114/68,7yrs ,0,DM f/u  R elbow pain  knee pain R>L ,1,1,1,1,1,1,1,1,1,1,1,1,0,,1,0,0,0,0,0,0,0,0,0,0,0,0,,acetaminophen 1g bid prn   diclofenac 1% topical gel   asa 81  atorvastatin 40  gabapentin 300 bid   glipizide ER 2.5mg   metformin 1g bid   tamsulosin 0.8mg daily ,never done ,0,1,0,0,," -chronic R>L knee pain, hx of R TKA, worse in winter   -R elbow pain since last yr.   -diabetic neuropathy in feet ",1,1,0,0,0,exercise   PT ,PT ,tylenol   meloxicam  tramadol ,tylenol   meloxicam  tramadol ,0,0,0,0,0,0,"decrease knee pain so pt could continue to work, walk and remain active ","pt lived independently with a roommate, spoke about a daughter but was not very involved in pt's care ","pt's level of pain, functionality (being able to walk as much he did, work) ","Pt with improvement in R knee pain initially after R TKA but pain returned soon after. Hx of steroid injection in that joint prior to surgery as well as PT before and after surgery.  Tylenol stopped being very effective. Avoiding nsaids due to DM. Tried topical products such as capsaicin, voltaren but pt did not find them helpful.  Continued with tylenol prn though not very effective anymore.  What other options should/could have been tried? ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
46,,6/3/22 10:01,OUDPM-46.1-4,4/8/22,6/10/22,MB0818,58,1,0,0,0,1,0,0,0,1,"5'7""",223 LB,35,86,158/92,OVER 4 YEARS ,,Chronic Norco refills   Depression   ,1,1,1,1,1,1,1,1,2,1,1,1,2,,1,1,0,0,0,0,0,0,0,0,0,1,0,,ALBUTEROL 90MCG PRN   AMLODIPINE 5MG   CLONIDINE 0.2MG PRN   DULOXETINE 60MG   FUROSEMIDE 20MG   MIRTAZIPINE 30MG   NARCAN 4MG ACTUATION   SEROQUEL 200MG   , + OPIATES ,0,1,0,,,1- oral pain   2- ?  3- can be > 8/10 ( self reported)   4- chronic   5- ?  6- cancer   7- ?,0,0,0,0,0,Patient was managed on several non-pharm and pharm therapies including CBT,Patient was managed on several non-pharm and pharm therapies including CBT,"all non-opioid pain management options including NSAIDs, gabapentin, oral numbing agents such as chlrohexadine",NSAID  Norco   chlorhexadine,1,1,1,1,0,1,Early on we had clearly discussed and set the goals and expectations of discontinuing MAT treatment and treating chronic oral pain related to his primary squamous cell carcinoma of oral cavity. ,no adequate social/ family support ,"We monitor his goals with ongoing assessment of his pain management, ability to function, self care management, engagement in supportive networks including attending groups and BH visits   ","This is a 58 yo M with PMH of chronic OUD with IN heroin use for several decades who came to us for MAT on BUP/Naloxone. Pt. was Dx with primary squamous cell carcinoma of the oral cavity who is now on chronic Norco.      * He has since been D/C'd off BUP and on high doses of ATC Norco for chronic oral pain management   * Has been on Norco since 6/2019 following massive oral surgery for malignancy  *He has been referred to Pain Clinic - they will not manage his pain/Norco  * He has (since Dx) had multiple oral reconstructive surgeries   * He is now in the process of getting dental implants ( not dentures)     1- This patient has not been on suboxone for his OUD since 6/2019 and has since been on chronic Norco for his oral cancer with hx of multiple extensive surgeries, most recently with dental implant surgery.  - He is currently on 180 tabs of Norco 10 around the clock.  His UDS confirms compliance, he attends all appt.  ILPMP appropriate for on-time and no outside refills.      1) At what point do we discuss weaning given the patient history of OUD? We have tried to wean, unsuccessfully, in the past- despite concerted efforts including beefing up BH and Psych support, peer support and provider support.  Pt. becomes incredibly anxious even weeks prior to running out of his current Rx.      2) What are realistic expectations and goals for this patient given his cancer and OUD and some ways to get the patient to feel confident in weaning  ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
47,,6/7/22 17:12,OUDPM-47.1-4,5/24/22,6/10/22,MH0914,40,1,0,0,0,0,1,0,0,1,5ft 11in,250lbs,34.9,111,138/90,2 months ,0,Lumbar spinal stenosis with consistent 8/10 pain affecting mental health and functionality,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,1,0,0,0,0,0,1,0,0,0,1,0,, - olanzapine to 15 mg at bedtime for psychosis    - bupropion XL 450 mg daily for depression    - hydroxyzine 50 mg three times a day as needed for anxiety    - venlafaxine ER 225 mg daily for depression    - divalproex ER 500 mg twice a day for mood stabilization    - trazodone 50 mg at bedtime for sleep ,,0,1,0,1, -Helped me to understand how intertwined his physical pain and his mental health are.     -Sent pt I-COPE patient education materials ,"lumbar spinal stenosis, constant 8/10 pain, really bad pain with sitting, can walk but pain gets bad after walking for more than a few minutes. Pain started at 17 from playing football. Got so bad last year that he had hallucinations. He said sometimes he still has hallucinations in his periphery now",0,1,0,0,0,"physical therapy - made it worse, stopped in April, stretching, yoga, walking - all seem to make it worse, lays in bed all day. Has been sleeping more to have relief from the pain.   Got a test to see if ablation could work but they determined it would not provide relief.   Said weight loss did not make a difference.   Only relief is from vaping THC ","physical therapy - made it worse, stopped in April, stretching, yoga, walking - all seem to make it worse, lays in bed all day.   Got a test to see if ablation could work but they determined it would not provide relief. Also has had a few steroid injections in the past  Only relief is from vaping THC and OMT appts ","Gabapentin, voltaren gel, SSNI?   ","Gabapentin, voltaren gel ",0,0,0,0,0,0,Decrease consistent pain   Be able to complete ADL's with less pain   Improve mental health as related to pain ,"BH counselor, Psych APN, nurse care manager, PCP/OMT provider ",Nurse care manager checks in at least monthly on progress of goals ,I'm concerned that he's so young and this pain is clearly getting worse and so severely impacts his life and his mental health.     I noticed he isn't on any pain medications - he mentioned to me once that he can't have NSAIDS due to his genetic clotting disorder factor V Leiden mutation. Could that also be why he doesn't have opioids prescribed?     Any interventions we should try again?     Ways for physical therapy to be effective and not harmful?     Any other recommendations for him? ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
48,,6/7/22 13:37,OUDPM-048.1-4,4/29/22,6/15/22,PH1110,72,1,0,0,0,1,0,0,0,1,5'9,259 lbs,38.3,84,"160/98, 101/69",Since October 2020,0,"Nutrition and Diabetes management education including HBP, CKD prevention. ",1,1,1,1,1,3,1,1,3,2,3,1,1,"Daughters, Assistant Living Facility",0,0,0,0,0,0,0,1,0,0,0,0,0,,"Albuterol Sulfate Inhaler, Fluticasone Propionate 50 mcg (Allergic Rhinitis), Atorvastatin 40mg (Hyperlipidemia), Furosemide 40 mg (diuretic), Hydroquinone 4% (hyperpigmentation on face), Lisinopril 20 mg, Metroprolol ER 25 mg (HBP), Meloxicam 15mg (Osteoarthritis of knee, Back pain), Metformin 500 mg (DM), Triamcinolone .1% (leg scar), Warfarin 4 mg (COLD, Vitamin D. ",Negative.  Nicotine dependence. ,0,1,0,0,,"Leg pain (abnormal gait, no walking assistance used, knee brace), back pain, finger deformity. Reports he has access and uses exercise bike at residence and attempts not to be sedentary.",1,1,1,0,0,"ROM exercises.  Referral to podiatry for lower limb pain. Low impact physical activity including walking, stretching, stationary bike.","Knee brace.    Stationary bike use, yet inconsistent. ","Pain management from Meloxicam and IBU, as needed.","Meloxicam, refilled at this visit; also mentioned IBU, as needed.",0,0,0,0,0,0,"Provider - It appears to be medication management daily and/or prn.    Myself - Reduce high sodium, high sugar, highly processed meals as well as limit animal protein (Goal: reduce inflammation).  Monitor food preparation and reduce/eliminate all dairy products (Goal: reduce inflammation and mucus production). ","Daughter is main family support.  Assistant-Living residence provide medication compliance, blood sugar monitor, blood pressure monitoring and all referrals back to provider. ",Compliance with 3-4 month diabetes management visits with provider and CDE. ,"At the last visit, pt shared with provider and CDE his past history of opioid use.  He has been clean for 11 years and feels proud he has overcome this part of his life through his faith in God and disassociation within this environment.    Do you recommend adjusting pain medication to reduce symptoms of CKD?  Do you recommend having provider create an ExerciseRx or return to PT?  Or  Do you recommend referring pt to Behavioral Health to address elevated HBP, HBA1c and Chol levels based on his diet choices versus his perspective of surviving the complications of past substance use, unlike his counterparts?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
49,,6/16/22 20:07,OUDPM-049.1-4,,6/17/22,KW0909,55,2,0,0,0,1,0,0,0,1,5'4'',196,34,80,111/75,2 years,1,chronic pain,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Norco 10mg TID, Gabapentin 300mg TID, Duloxetine 60mg QD, Atorvastatin 80mg QD, Lidocaine patches and creams    ","01/24/2022 +opiate (expected), +gabapentin (expected). +THC in past (reports use -expected). 11/18/2021 and 05/03/2021 +cocaine (denies use)  ",0,1,0,0,,"She began showing up to RUSH ED in early 2019 with dyesthesias or abnormal sensations in her mid back and anterior chest. In subsequent ED visits she also reported cervical radicular pain and lower back pain, including LLE radicular pain. Now she reports shooting pain, burning pain, and tense muscles to the point of rigidity affecting her gait at times resulting in using a walker or cane.",1,1,0,1,1,RUSH Ortho surgery counseled over cervical decompression and fusion surgery (completed 07/2019). They also recommended revision surgery after continued symptoms which she declined. They also discussed placing a spinal cord stimulator which she declined.,"Cervical decompression and fusion surgery (07/2019), Physical therapy 8/2019 - 12/2019. She uses epsom salt soaks and heat therapy when running out of opioid pain meds.","Initially NSAIDs, tramadol, opioid (Norco 10mg) prescribed off and on by ED visits and by Ortho Surg. UC Pain Management performed 6 lumbar epidural steroid injections, refused to prescribe opioid meds.  UIC Primary Care refused to prescribe opioid pain meds.","NSAIDs/tramadol initially. Amitriptyline QHS. Duloxetine QD, Gabapentin TID. Lumbar ESI. Norco 10mg TID",1,1,1,1,1,0,"Be more physically active, Do hobbies and activities, Reduce stress, Take less medications",Daughter is involved and helps her when she is stretching monthly Norco scripts to 35 days ,"Monthly check in, using ICope smartset. Encourage tracking minutes of walking vs other exercise, tracking how many minutes of deep breathing or practicing mindfulness, and continuing to increase days between refills. Encourage behavioral health follow up.",With 50% those with chronic pain inadequately treated how can I best support her without increasing risks OUD or OD? Has anyone else been put in  the position that they feel pressured to prescribe pain meds since they are the last resort for patients' uncontrolled pain and what have they done? Anyone else with other weaning strategies?,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
50,,6/23/22 16:42,OUDPM-050.1-4,6/14/22,6/24/22,LG0916,52,2,0,0,0,1,0,0,0,1,"5'3""",168 lb,29.76,74,142/90,1 day,0,Right hand pain,3,3,1,3,3,1,3,3,1,1,1,1,0,,1,0,0,0,0,0,0,0,0,0,0,0,0,,"albuterol prn, norvasc 10 mg daily, pepcid 20 mg bid, hctz 25 mg daily, lidocaine 5% patch, naproxen 500 mg bid (not helping,so taking someone else's tylenol #3)",N/A,1,0,0,0,,R hand pain and swelling x 1 month. Severe. throbbing with pins and needles and pain and numbness radiating up to shoulder. No trauma.,0,0,0,0,1,meditation and mindfulness (used the icope smarttext),Not sure. no follow up yet,gabapentin,hopefully she is taking the gabapentin,0,0,0,0,0,0,n/a. attempting to find out the cause of her pain. She had a positive ANA in the past and it was repeated and it was again positive centromere pattern >1:1280,Not discussed,By relief of pain. Although still trying to get a hold of her to discuss her results and get her to rheumatology.,"With her swelling on exam, I was tempted to prescribe Tylenol #3. But since she was a new patient to me, I prescribed the gabapentin since the description of her pain seemed more neuropathic. ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
51,,6/23/22 22:51,OUDPM-051.1-4,5/19/22,6/24/22,TB0326,51,2,0,0,0,0,1,0,0,1,5ft 5in,160lbs,26,90,116/78,7yrs,0,many varied chronic complaints including chronic pain ,1,1,1,1,1,3,3,3,3,1,1,1,0,,0,1,0,0,0,0,0,1,0,0,0,0,0,,"alprazolam 1mg tid prn  aripiprazole 5mg   prazosin 2mg   duloxetine 90mg  lamotrigine 200mg  hydroxyzine 50mg   albuterol, amlodipine 10mg, Breo, carvedilol 25mg bid, hydralazine 10mg bid, statin, spiriva, meclizine, loperamide. ",not done ,0,1,0,0,,"neck, low back pain, shoulders and leg b/l.   hx of spinal stenosis cervical and lumbosacral radiculopathy. hx of spinal surgery. ",1,1,1,0,0,PT  heat   ,remote hx of PT.   heat packs ,"hx of OUD, hx of dependence on norco.   hx of  tylenol #3 but had elevation in LFTs.   possible hx of multiple MIs, avoiding nsaids.   steroid injections, epidural.   flexeril ","hx of OUD, hx of dependence on norco.   hx of  tylenol #3 but had elevation in LFTs.   flexeril ",0,1,0,1,0,0,"reduce chronic pain, improve mobility/functionality. ",intermittently has a supportive boyfriend. ,regular telehealth visits. ,Can pt's psych meds be adjusted to help with pt's pain?   is it reasonable to cont to avoid opioids given pt's history?   options for pain control/management?,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
52,,7/7/22 20:54,OUDPM-052.1-4,,7/8/22,HL0518,65,1,0,0,0,1,0,0,0,1,69.5 in,165,23,78,124/82,2 years,0,chronic back and neck pain,1,1,3,1,1,3,1,3,3,1,1,1,0,,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Tramadol 50 mg every 8 hours prn, Lisinopril, Folic acid, Atorvastatin, Tylenol, Symbicort, Albuterol, Lidocaine Ointment 5%, Gabapentin 600 mg , Tamsulosin, Pantoprazole",N/A,0,1,0,0,,,1,1,1,0,0,"PT, heat/cold",PT,Topical  Tylenol  Gabapentin  Tramadol  Morphine,see above,1,1,0,0,0,1,maintain his activity level,limited  lived with his mother,monthly clinic visits,How to approach patients with undertreated chronic pain who have not achieved adequate pain relief from nonpharm treatments and non-opioids?  He knew not to ask.  How to address his chronic pain with alcohol abuse?  When to get urine tox screens?,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
53,,7/13/22 11:17,OUDPM-053.1-4,4/19/22,7/15/22,MR0409,56,2,0,0,0,1,0,0,0,1,"5'3""",157 lb,27,76,127/88,6 years,1,Pt s/p internal fixation (at Stroger) with FU surgery and repair by Ortho out of WSH. ,1,1,1,1,1,2,2,2,2,1,1,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,acetaminophen 500mg BID   bupropion SR 100mg Q BID   Norco 10-325mg Q 4 hrs   ,n/a,0,1,0,0,,"right ankle pain, usually complaints of > 8/10 pain when not taking Norco. this is a post-traumatic injury ( roughly 2-3 yrs ago). ",0,0,0,0,1,patient was encouraged to engage in BH support.  Has been on/off in her engagement.  Pt. has been leaning on her church and friends for additional support ,see above ,"patient was treated with NSAIDs, NDRI, T3, banophen, gabapentin, oxycodone, tramadol",currently on Norco ATC and Tylenol PRN for breakthrough pain.  ,0,1,0,1,0,0,In collaboration with her surgeon we agreed that patient is well past her post/op recovery and should be moving forward with weaning off or to the lowest effective quantity of Norco for pain management.  This has been difficult,poor family support ( per patient).  Great social support.  ,We have been addressing progress every month when meeting/telehealth for refills.  ,My concern for this patient has become her physical dependence on Norco.  She is in denial and is convinced she cannot function without her Norco.  Prior to this traumatic injury patient had never been on any medication at all.  I am finding it difficult to wean her due to her increase anxiety around weaning.  I believe her pain to be very real and am working on getting her to accept that she will always and likely forever have some level of pain due to her injury.  It has been difficult to wean her.  ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
54,,7/13/22 19:46,OUDPM-054.1-4,7/13/22,7/15/22,MH0914,40,1,0,0,0,0,1,0,0,1,5ft 11in,251lbs,35.1,98,141/95,4 months,0,Follow up review on my pt with lumbar spinal stenosis leading to his chronic pain for the last 23 years. ,1,1,1,1,1,1,1,1,3,1,1,1,0,,0,1,0,0,1,0,0,1,0,0,0,1,0,,Copied over from Psych APN's note:   *decreased divalproex due to twitching in arms and legs when he lays down sometimes    continue olanzapine to 15 mg at bedtime for psychosis    - continue bupropion XL 450 mg daily for depression    - continue hydroxyzine 50 mg three times a day as needed for anxiety    -continue venlafaxine ER 225 mg daily for depression    -decrease divalproex ER 500 mg twice a day for mood stabilization     -continue trazodone 50 mg at bedtime for sleep ,,0,1,0,1,"While he really has tried nearly every intervention, these conversations have given me an open door to continue to check in on his pain and brainstorm options together. ",lumbar spinal stenosis. constant 8/10 pain. really bad pain when sitting. Can walk but pain gets bad after a few minutes. Has had pain for 23 years now. ,0,1,0,0,0,"Hasn't worked: physical therapy, tens unit, acupuncture, progressive muscle relaxation, music, walking   15 years working in construction - feels movement does not help and only causes further damage. ","Do work: OMT, BH, little stretches in bed ",Has tried norco and vicodin in the past and said they didn't help    Feels gabapentin does not help ,venlafaxine for pain and depression,0,0,0,0,0,0,ability to complete activities of daily living ,Has reported limited support system ,"By his psych APN, his BH provider, and me - his nurse care manager"," - Encouraged him to try a few minutes of walking every day and build up but he feels that, for him, movement really does do damage.     - Maybe better to focus less on the pain and more on his function of being able to complete other goals     - History of physical abuse and sexual abuse -    trauma large trigger for chronic pain. Maybe I can connect him to a pain psychologist like Dr Beckman    Do you all have thoughts or suggestions for him or patients like him?   ",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
55,,9/15/22 9:05,OUDPM-055.1-5,8/20/20,9/16/22,FU040355,67,1,0,0,0,0,1,0,0,1,172.7 cm,109.77 Kg,36.8,73,110/80,Years-until came to Access,0,Last time I cared for this patient was in 2020 in primary care practice.  He has memory problems and his wife demanded a CT be done to find out what is wrong with his brain.,1,1,1,1,1,1,1,1,1,1,2,1,1,Spouse,0,0,0,0,0,0,0,0,0,0,0,0,1,F13.20 Benzodiazepine dependence; F10.20 Alcohol Use Disorder,Alprazolam 1 mg tablet at bedtime  buprenorphine-Naloxone 1 film buccally QOD  Linzess 145 mcg daily,N/A  I am not the OUD treating provider,0,0,1,0,,,0,0,0,0,0,,,,,0,0,0,0,0,0,,,,,0,1,0,0,0,0,0,0,0,0,0,61; had been using for 5 years at time of Dx,"He recognized he needed to get off heroin, which he started using after he because addicted to prescription opioids.",0,0,0,1,1,0,0,0,0,0,0,0,0,0,,1 mg alprazolam at bedtime for sleep; prescribed by another provider.  I would not give this to him any longer so he started seeing another provider in the practice who would.  ,1,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,0,0,0,0,,0,0,0,0,0,0,0,0,1,Unknown-I was not the treating provider for OUD,N/A,1,0,0,buprenorphine-Naloxone 1 film buccally QOD,0,0,1,0,0,Patient demonstrated limited insight and judgement ,0,0,0,0,0,1,0,0,0,0,0,0,0,1,1,1,0,0,0,0,0,0,Complex primary care cases-highlights the problems providers have managing complex cases when other providers are involved.  Caring for this patient and a few others was the reason I pursued getting X waiver when the rules allowed NPs to become X-waiver providers.,2
56,,9/16/22 6:49,OUDPM-056.1-5,7/11/22,9/16/22,MG0925,55,1,0,0,0,0,1,0,0,1,74in,245lb,31.5,78,100/80,approx 17 mos,1,pain and swelling of right lower leg,1,1,1,1,1,1,1,1,1,1,1,1,0,,0,1,0,0,0,0,0,0,0,0,0,0,0,,Methadone 90mg  ibuprofen 600mg  chlorthalidone 25mg  buspirone 7.5mg  pantoprazole 40mg  miralax  simethicone  nicotine patch    ,,0,1,1,0,,pain and swelling in right foot and ankle; numbness in right foot; started the week prior to the appt; affected by weight bearing and working a full day,0,1,1,0,0,"ice, elevation, compression","ice, elevation","NSAIDs, Tylenol",Ibuprofen and Tylenol,0,0,0,0,0,0,,Pt is very family focused.  He lives with son.  Pt and his son take care of pt's mother and aunt who are both older women with limited mobility,follow up appointments,Best way to use pain medications in acute situations given long term methadone and history of constipation; how closely to follow up,0,0,0,0,0,1,0,0,1,0,0,in early adulthood,Improved health,0,1,0,0,0,0,0,0,1,1,0,0,0,1,Methadone,90 mg of methadone  no heroin since 03/2022  marijuana smoked at night primarily to help with sleep  cigarettes smoked throughout the day  ,1,0,1,1,0,0,0,0,0,0,0,0,1,1,0,0,0,0,0,0,,0,1,1,0,0,1,0,0,0,,Gad =12  phq = 10  mdq = 4,0,1,0,90mg,1,0,0,0,0,,0,1,0,0,0,0,0,1,0,1,0,0,0,1,1,0,0,0,1,0,0,0,pt has been successfully weaning off of the heroin and is in methadone program to help wean down the methadone; how/when to work on cessation of marijuana and/or cigarette use,2
57,,9/20/22 20:21,OUDPM-057.1-5,6/20/22,9/23/22,EC0453,69,2,0,0,0,1,0,0,0,1,"5' 1""",122 lbs,,88,155/77,4 yr,1,"Routine healing of pelvic hip fractures  Chronic UE ulcer, non routine healing.    Fall from stool in bedroom, 12/11/21, hospitalization, Multiple Pelvic fx 3. Non surgical management. Hospital subacute and rehab in house, Pt declined, home therapy/PT arranged.    Walker provided post hosp, Wheelchair arrangements.     Hep C chronic    DM with skin complications. ",1,1,3,1,1,2,2,2,2,1,3,1,1,Husband,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Jardiance 10 QD  Lis/HCTZ 20/12.5 QD  Nicotene patch 14 mg/24  SIlveden cream 1%  ASA 81  Methadone  Atorvastatin 20  Basaglar Kwickpen U100, 10 units QHS  Colace 100  ",Opioid  Cannibus,0,1,0,0,,"R hip pain, ache, most of active hrs, ambulation issues, ADL's",0,1,1,0,0,PT,PT-home PT,"Topical pain creams, patches    Cannibus discussed. ","Topical therapies, capsaicin, lidocaine patches",1,0,0,0,0,1,Continued PT with goals and Methadone Tx,continued supports with ADL's,"Home health service referral and discussion, Pt and family reluctance.  ",cannibus usage. role for edibles/smoking  Role for lidocaine patches/contraindications  post PT completion   ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
58,,9/27/22 19:30,OUDPM-058.1-5,9/13/22,9/30/22,Jane Doe DOB 9/19/1961,61,2,0,0,0,0,0,0,0,2,66 inches,172,,60,122/80,Initial Visit,0,"Patient and her partner presented on the same day to establish care.  Patient concerned regarding months of pain in her bilateral feet, and wishing to transfer care to our clinic.",1,1,1,1,1,1,1,1,1,1,1,1,0,,1,0,0,1,0,0,0,0,0,0,0,0,0,,Advair Diskus 250-50 one inhalation BID  Escitalopram 20 mg daily  Gabapentin 600 mg PO BID  Moexipril 15 mg QD  Nifedipine ER 60 mg daily  Trazodone 50 mg QHS  Ventolin MDI 2 puffs QID prn  ,None available.,0,1,1,0,,"Patient states 9-12 months of progressive bilateral foot and ankle pain.  No trigger known as to onset of pain.  Pain more in lateral feet and heels than toes.  Pain is a burning/pins and needles sensation.  Patient also notes some achiness and stiffness at times in her feet.  Symptoms are better with rest, worse with prolonged standing.  There has been no redness, warmth or swelling.  No injury.  Patient has no history of inflammatory or other joint disease. There is no history of diabetes.  Most recent PCP has tried gabapentin with dose currently at 300mg bid, but patient does not feel that this has helped.  Pain has caused the patient to miss work at times, and she is concerned regarding this and wants answers and pain relief.",0,1,0,0,0,"Physical therapy, referral for diagnostic studies (EMG was scheduled per prior PCP,  increasing gabapentin dosing, topical NSAIDs, trial of duloxetine.  I offered Podiatry consult as some of patient's pain seemed to be related to standing and was achy and stiff.  ",Patient became upset at the above and wanted a prescription for hydrocodone as nothing seemed to be helping and she was worried regarding missing work and wanted answers and relief.,"Increased gabapentin, topical NSAIDs, trial of duloxetine.","None, patient became upset and left.",0,0,0,0,0,0,,"The patient's partner also saw me that day, and since that time has established with me as their PCP.  They have not mentioned that their wife was upset with the visit to me.",,What strategies work to engage patients who may be focused only on opiates as treatment for their pain?      How can I better manage the conversation and patient expectations in this situation?  ,0,0,0,1,0,0,0,0,0,0,0,"Unknown, although WI PDMP search shows recent multiple prescriptions for hydrocodone from a few practitioners in the area. ",Goals were to reduce pain and to be functional at work.,1,0,0,0,0,0,0,0,0,1,0,0,0,0,,,1,0,0,0,0,0,0,1,0,0,0,0,0,0,0,0,0,0,0,0,,0,0,0,0,0,0,0,0,1,PHQ 2 was 0.,PHQ 2 was 0.,0,0,0,,0,0,0,0,0,"Patient was in their sixties and still trying to work, likely for financial reasons.  They wanted pain management that was rapidly accessible and that allowed them to continue working.",0,0,0,0,0,1,0,0,0,1,0,0,0,0,1,0,0,0,0,1,0,0,"I work for a Tribal Clinic which is largely subsidized by Tribal income from casinos. We have quite strict policies regarding opiate prescribing, and require Pain Clinic management for patients on chronic opioids.  We also offer a robust MAT/BH program, fentanyl test strips, readily available Narcan to the community, low cost AODA treatment, and a partnership with social services and law enforcement to reduce opiate use disorder and overdoses.  These efforts have been quite successful in our community. Tribal members appropriately feel ownership in their clinic, but also expect that their wishes will be heeded, even if it involves a treatment decision that is not in the best interest of them, or of the community.    How can I approach these interactions in a better way?    How can I engage patients to consider treatments beyond opiates?    How can I communicate to Tribal members that I want to treat their pain, but also have a duty to clinic policy and to the community to prescribe judiciously?",2
59,,9/29/22 16:16,OUDPM-059.1-5,,9/30/22,TR0808,86,2,0,0,0,1,0,0,0,1,,,,,,3 months,1,Chronic pain in setting of spinal stenosis and polyneuropathy. ,3,1,3,1,3,3,3,3,3,3,3,3,1,Daughter and homemakers,0,0,0,0,0,0,0,1,0,0,0,0,0,,"Eliquis, simvastatin, losartan, amlodipine    Cymbalta, Gabapentin 300 TID now 100 QHS (was not taking), lidocaine patch PRN, hydrocodone 5-325 PRN",,0,1,0,1,Multi-modal approach helping to decrease her pain ,"1. Location: all over; most notable in shoulder joints, knees, and legs   2. Throbbing + pins and needles   3. 10/10 keeps her up at night   4. Consistent, all day long   5. Home   6. Pain worse with movement   7. Significantly decreased mobility ",1,1,0,0,0,"Lidocaine patch, voltaren gel, Bengal cream; discussed distraction ideas ie spending time with friends and family, going to church ",All of the above ^,Continuing with current therapy,Started on the gabapentin again (low dose),0,0,0,0,0,1,Physical Therapy ,,Check in every few months ,What are we missing? How to prevent dependence on narcotic medications? Limit use? ,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
60,,10/3/22 11:21,OUDPM-060.1-5,10/4/22,10/7/22,JT0713,61,2,0,0,0,1,0,0,0,1,"65.5 """,143 #,23.43,70,130/77,3 months,1,"History of Bipolar I disorder, prolonged grieving, increased anxiety, not sleeping.  ",1,1,1,1,1,1,1,1,1,1,1,1,0,,0,1,0,1,0,0,0,0,0,0,0,0,1,Alcohol and substance abuse disorder,Fluoxetine 60 mg  Quetiapine 50 mg HS  Hydroxyzine 25 mg prn,N/A,1,0,0,0,,"Generalized aching, (2) body hurts, (3) did not quantify, (4) throughout the day, (5) home/not currently working, (6) not sleeping, (7) irritability and intolerance of events in her life.",0,0,1,0,0,Promoting better sleep  Therapy with an LCSW  Promoting daily walking she commenced on her own,Patient was not taking quetiapine; on re-evaluation I reminded her to take 50 mg before bedtime and implement sleep hygiene procedures.  A daily walk,Tylenol Arthritis 2 tablets in the morning and evening if needed,Tylenol Arthritis 2 tablets in the morning and evening if needed,0,0,0,0,0,0,To get through the day more comfortably and be able to enjoy taking care of two year old grandson.,"She lives for her two year old grandson, the only child of her late son.  Mother of the child brings the child to her regularly for visits and care.  This gives her a purpose.",I continue to follow this patient monthly.,"Would you manage a patient differently with bipolar 1 disorder that is only using opioids if she has a manic episode?    Body aching and discomfort seems to be associated with not sleeping, sleeping without disturbance when taking quetiapine HS.  Would you have done anything different?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
61,,10/12/22 15:30,OUDPM-061.1-5,9/20/22,10/14/22,AT,64,2,0,0,0,1,0,0,0,1,5 ',114 lbs,,79,120/87,4 years,1,DVT follow up  Poor nutrition  Referral to eye specialist Cataracts,1,1,1,1,1,3,1,1,3,1,3,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,albuterol inhaler  MVT  Ibuprofen  Gabapentin 100 mg TID  Xarelto 15 mg BID  FAmotidine  SIngulair  QVAR 80 1puff BID  Prednisone 20 mg QD  Naloxone,,0,1,0,0,,Left LE ache    B/L knee arthralgias-request for hyalgen based injections,1,0,1,0,0,monitoring,,NSAIDS careful-ibuprofen,ibuprofen,1,0,0,0,0,1,XArelto continuation,Social complexity of multi generational home e with conflicts between DTR and grandchildren,"Clinic visits, U/S recheck",DVT associated pain control,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
62,,10/12/22 19:26,OUDPM-062.1-5,10/4/22,10/14/22,BC22851,71,2,1,0,0,0,0,0,0,2,61.5 inches,149,27.6,68,110/64,Initial Visit,1,"Epigastric pain, to establish care.",1,1,1,1,1,1,1,1,1,1,1,1,2,,0,0,0,0,0,0,0,0,0,0,0,0,1,"Anxiety, unspecified.",Advair 250/50 1 puff BID  Ventolin MDI 2 puffs prn  Aspirin 81 mg QD  Atorvastatin 20 mg QD  Calcium/Vitamin D  Diclofenac 75 mg BID  Famotidine 20 mg BID  B complex vitamin daily  Furosemide 40 mg QOD  Januvia 50 mg QD  Metformin 500 mg BID  NTG 0.4 mg SL prn  Synthroid 50 ug QD  Montelukast 10 mg  QHS  Pregabalin 200 mg BID  Alprazolam 0.5 mg PRN (uses infrequently)  Tramadol 50 mg PRN (2-3 a day),Positive for THC,0,1,0,0,,"Inflammatory polyarthropathy with positive RF, prior methotrexate, hydroxycholoroquine and prednisone treatment. Lost contact with Rheumatology due to frequent moves.  Also diagnosed with fibromyalgia.  Pain is diffuse, muscles and joints (feet, back, neck) that presents throughout the day.  Patient uses tramadol when pain is a 7 or higher.  Diffuse ache with stiffness in these areas,  and also restless/cramping/tingling in feet, worse at night.  Recent toe fractures and ORIF, with recent prescription for Diclofenac.  Patient has also tried mirapex and gabapentin without relief.  Pain worse in the cold and damp.  ",1,0,1,0,0,"Exploration of other soothing activities when pain is peaking rather than tramadol, use of calming techniques for periods of anxiety, pursuing activities patient enjoys that keep them active and engaged (grandchildren).  Offer of physical therapy.","Patient open to exploring what besides Tramadol helps pain, and learning what soothing techniques might work.  ","Pregabalin -- continuing this at current doses.  Alprazolam -- patient does not like to take this -- it was discontinued, patient believes they may be able to look at other options to self calm during acute anxiety.  Patient thought this was possible.  Tramadol -- use only rarely for breakthrough pain to avoid frequent use/side effects/tolerance.  Patient uses CBD and THC at night, and acetaminophen during the day prn.","Alprazolam discontinued.  Med Treatment agreement for pregabalin at current dosing.  Tramadol refilled, with referral to Rheumatology, in the hope that other methods besides opiates might be an option for treatment.  Diclofenac was discontinued as patient was having acute epigastric symptoms since starting this.  Patient will try Voltaren QID to her toes instead of the Diclofenac.",0,1,1,1,0,0,"Attempting to maximize function and minimize times when pain was at the threshold where opiates were needed.     Frank ongoing conversation between the two of us regarding issues of drug interactions (alprazolam/tramadol/pregabalin/THC), tolerance, side effects and potential impairment or overuse.","Patient widowed due to COVID in April.  She lives now by her children and grandchildren, but plans to spend a few months in Nevada this winter.",Follow up visits. Monitoring of medications.  ,"1.  Our policy is not to prescribe chronic opiates without specialty (typically Pain Clinic) co-management and recommendation.  My hope is that patient may have a few additional options for treatment offered by Rheumatology and we can taper or minimize tramadol.  Patient cannot tolerate oral NSAIDs.  What other options are available to her besides the acetaminophen/topical Voltaren/pregabalin/and prn tramadol?  2.  If patient needs a dose escalation of tramadol due to pain -- how do I approach this?  3.  Patient was very forthright that she uses THC sometimes at night to help with sleep.  She was aware that this would be found on a drug screen.  I was accepting of this admission and explained that occasional  use of THC or CBD would not cause me to void her med treatment agreement, but heavy use of THC may be an issue.  We agreed to maintain open dialogue about this.  What would others do in this circumstance?",0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
63,,10/21/22 0:23,OUDPM-063.1-5,5/4/22,10/21/22,061068WR,54,1,0,0,0,0,1,0,0,1,68in,187lb,28.4,76,152/92,2 years,1,alcohol abuse  back pain  pain in feet,1,1,1,1,1,1,1,1,2,1,1,1,0,,0,0,0,1,0,0,0,0,0,0,0,0,1,alcohol dependence,Antabuse  gabapentin  thiamine   vitamin b12  celebrex  lidocaine 5% patches,"8/17 - benzos, opiates, cannabinoids  8/10 - cannabinoids",0,1,0,0,,"low back pain, chronic ache, especially when working",0,1,1,0,0,physical therapy,none presently,lidocaine patches  NSAID prn  gabapentin,as above,0,0,0,0,0,0,ability to maintain ADLs/work,no family involvement  did finally move to own apartment and out of living situation with alcoholic roommate,"was supposed to follow up, but misses appts or ends up in ER frequently",How to help him adhere to alcohol use disorder treatment program  How to encourage regular follow up  Best option for pain management in this situation  How to encourage alternative treatments,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,2
64,,10/26/22 21:47,OUDPM-064.1-5,10/26/22,10/28/22,KS0524,71,2,0,0,0,1,0,0,0,1,"5'3""",267,,70,130/80,New patient ,1,"Establish care    Overwhelming CC is pain from chronic OA of knees. Describes as constant, sharp and crampy, 10 out of 10 in severity. Usually only able to subside to 8 with interventions she has tried. Ongoing for at least four years. ",1,1,3,1,1,3,3,3,3,1,1,1,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,,"Voltaren gel as needed   Diclofenac enteric coated 75mg BID  Norco 10-325 BID, PRN   Others: Lipitor, Albuterol, Oxybutynin, Insulin, Metformin",Positive for cocaine,1,1,1,0,,"Location: bilateral knees and lower back   Quality: sharp and crampy for knees. Shooting and radiating for back.  Quantity: 10 out of 10  Timing: constant  Environment: at home  Influencing factors: home circumstances, cockroach infestation  Associated manifestations: sleep disturbance, turning to smoking cocaine",1,1,1,0,0,Physical therapy,Physical therapy,Addition of gabapentin  Use of Tylenol,Gabapentin 100 mg nightly to start,0,1,1,0,0,0,,,Follow up with pain management  Close return follow up to clinic,Minimize risk  Concern for narcotic abuse versus misuse   Refused urine drug screen,0,1,0,0,0,0,0,0,0,0,0,,,1,0,0,0,0,1,0,0,0,0,0,0,0,0,,Norco 10-325 BID PRN; per patient generally 10 pills per week  Cocaine: reports a few times a month,1,0,0,1,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,,,0,0,0,0,0,0,0,0,0,,,0,0,0,,0,0,0,0,0,,0,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,1,0,1,0,0,0,Having frequent falls,2