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LESKO, JOHN J DOB: 01/13/1947 (75 yo M) Acc No. 233235 DOS: 07/14/2022
LESKO, JOHN J
75 Y old Male, DOB: 01/13/1947
Account Number: 233235
531 YARBORUGH WAY, THE VILLAGES, FL-32163
Home: 908-309-7558
Guarantor: LESKO, JOHN J
Insurance: MEDICARE PART B
Payer ID: 09102
PCP: SUNDEEP SHAH
Appointment Facility: PMA LSL
07/14/2022 CARLOS R RAMIREZ-RAMIREZ, MD
Check In: 04:54 PM EST Check Out: 04:46 PM EST
Reason for Appointment
Current Medications 1. TELEVISIT DOXY 908.309.7558 NEW ID
Taking 2. Televisit with video (DOXY) consultation. Communication via unsecure line with
Dexamethasone 6 MG Tablet 1 tablet Orally patient's verbal consent.
Once a day
Tiotropium Bromide Monohydrate 18 MCG
Capsule 1 capsule by inhaling the contents of the
History of Present Illness
capsule using the HandiHaler device Inhalation Interim History:
Once a day
* We initiate our videocall encounter by obtaining a verbal consent. The patient has
Tamsulosin HCl 0.4 MG Capsule 1 capsule been informed that;
Orally Once a day
Sodium Chloride 3 % Nebulization Solution By engaging with me using Doximity, they understand and agree that this
4 ml Inhalation Twice a day conversation may contain their personal health information and acknowledge that I am
Sevelamer HCl 800 MG Tablet 1 tablet with not responsible for the privacy policies or security of Doximity and they should review
meals Orally Three times a day these policies if they have any questions.
Levothyroxine Sodium 125 MCG Tablet 1
tablet in the morning on an empty stomach My location as a provider is the medical office and the patient's location is home.
Orally Once a day 75 y/o male new ID patient that presents by televisit. Patient had surgery and
Furosemide 80 MG Tablet 1 tablet Orally afterwards developed diarrhea. He was seen in the ER was said he had C.Diff. He
Once a day seen Fausto in Urgent care 06/09/22 and was given cholestyramine and
Budesonide-Formoterol Fumarate 160-4.5
MCG/ACT Aerosol 2 puffs Inhalation Twice a Metronidazole. He was seen again on 06/13 by Dr. Sundeep Shah and was given
day Vancomycin which still did not help.
Aspirin 81 81 MG Tablet Chewable 1 tablet
Orally Once a day Examination
albuterol 0.083% 2.5mg/3mL neb solution General Examination:
nebulization solution 1 vial (3mL) via nebulizer
every 4 to 6 hours
Televisit with Video (DOXY) Consultation.
Midodrine HCl 5 MG Tablet TAKE 1 TABLET Communication via unsecure line with patient's verbal consent.
BY MOUTH THREE TIMES DAILY
Metoprolol Succinate 25 MG Capsule ER 24 Assessments
Hour Sprinkle 1 capsule Orally bedtime 1. C. difficile diarrhea - A04.72 (Primary)
Not-Taking
Cholestyramine 4 GM/DOSE Powder 1 scoop 2. Generalized skin eruption due to drugs and medicaments taken internally - L27.0
Orally Once a day 3. Adverse effect of other systemic antibiotics, initial encounter - T36.8X5A
metroNIDAZOLE 500 MG Tablet 1 tablet 4. Colitis due to Candida species - B37.82
Orally Three times a day
Vancomycin HCl 125 MG Capsule 1 capsule Treatment
Orally every 6 hrs, Notes: c.diff resistant to
metronidazole 1. C. difficile diarrhea
Medication List reviewed and reconciled with Start Fluconazole Tablet, 100 MG, 1 tablet, Orally, ONCE A DAY, 14 day(s), 14 Tablet,
the patient Refills 0
Stop Vancomycin HCl Capsule, 125 MG, 1 capsule, Orally, every 6 hrs, Notes: c.diff
Past Medical History resistant to metronidazole
Abdominal aortic aneurysm. Clinical Notes: Received Metronidazole after fistulectomy and then started on
MPA S/P PLASMAPHERESIS AND Vancomycin oral x several weeks on this dialysis patient. Treatment of C.diff has
RITUXIMAB/CYTOXAN IN 2014. beeen completed, might be complicated with Vancomycin flushiong syndrome and
Surgical History now have selected flora with possible candidal infection.
Ablation 2012
Mitral valve repair 2012 2. Generalized skin eruption due to drugs and medicaments taken
internally
Family History Clinical Notes: Patient on prolonged treatment for C.diff colitis that received
Father: deceased 78 yrs, diagnosed with Metronidazole and then on Vancomycin 125mg po q 6 hrs for several weeks. Patient
Myocardial infarction, unspecified MI type,
unspecified artery on dialysis developed erythematous rash (Red Man Syndrome or Vancomycin
Mother: deceased 82 yrs, diagnosed with Flushing syndrome) where Vancomycin needed to be stopped. Selective skin and
Hypertension, unspecified type intestinal flora has an increase chance of getting a Candidal Colitis and possible
Candidal skin infection after the Flushing Syndrome. Will stop Vancomycin and start
Social History
on Fluconazole x 14 days and follow up after treatment.
ADL:
I CAN BATHE MY SELF: YES. I CAN
COOK/PREPARE MEAL: YES. I CAN FEED 3. Adverse effect of other systemic antibiotics, initial encounter
MYSELF: YES. I CAN REMEMBER MY NAME: Clinical Notes: Patient on prolonged treatment for C.diff colitis that received
YES. I CAN CLEAN MY HOUSE: YES. I CAN Metronidazole and then on Vancomycin 125mg po q 6 hrs for several weeks. Patient
CONVERSE MEANINGFULLY: YES. I CAN
Progress Note: CARLOS R RAMIREZ-RAMIREZ, MD 07/14/2022
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
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7/19/22, 7:31 PM Print Preview
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LESKO, JOHN J DOB: 01/13/1947 (75 yo M) Acc No. 233235 DOS: 07/14/2022
FIND MY WAY HOME: YES. I KNOW WHERE on dialysis developed erythematous rash (Red Man Syndrome or Vancomycin
I LIVE: YES. I CAN CONTROL MY BLADDER: Flushing syndrome) where Vancomycin needed to be stopped. Selective skin and
YES. I CAN DRESS MYSELF: YES. I LIVE
INDEPENDENTLY: YES. I KNOW THE intestinal flora has an increase chance of getting a Candidal Colitis and possible
CURRENT DATE: YES. I CAN CONTROL MY Candidal skin infection after the Flushing Syndrome. Will stop Vancomycin and start
BOWEL: YES. I CAN OPERATE A MOTOR on Fluconazole x 14 days and follow up after treatment.
VEHICLE: YES. I CAN RECOGNIZE FAMILIAR
FACES: YES. I USE PUBLIC
TRANSPORTATION: YES. 4. Colitis due to Candida species
Sexual History:
Clinical Notes: Patient on prolonged treatment for C.diff colitis that received
Details of Sexual History
Are you sexually Metronidazole and then on Vancomycin 125mg po q 6 hrs for several weeks. Patient
active?
No. on dialysis developed erythematous rash (Red Man Syndrome or Vancomycin
Drugs/Alcohol:
Alcohol Screen (Audit-C)
Did you have a drink Flushing syndrome) where Vancomycin needed to be stopped. Selective skin and
containing alcohol in the past year?
Yes, How intestinal flora has an increase chance of getting a Candidal Colitis and possible
often did you have 6 or more drinks on one Candidal skin infection after the Flushing Syndrome. Will stop Vancomycin and start
occasion in the past year?
Never (0 point), How on Fluconazole x 14 days and follow up after treatment.
many drinks did you have on a typical day when
you were drinking in the past year?
1 or 2
drinks (0 point), How often did you have a drink
containing alcohol in the past year?
Never (0 Visit Codes
point), Points
0, Interpretation
Negative. 99213 Office Visit, Est Pt., Level 3.
Allergies Procedure Codes
Lisinopril
Azathioprine
1159F MED LIST DOCD IN RCRD
Levofloxacin 1160F RVW MEDS BY RX/DR IN RCRD
Atorvastatin 1126F AMNT PAIN NOTED NONE PRSNT
1170F FXNL STATUS ASSESSED
Hospitalization/Major
Diagnostic Procedure Follow Up
SHANDS for pneumonia sept 2020 2 Weeks (Reason: F/u on Response to treatment)
SHANDS for Kidney disease Sept 2021
Review of Systems
General/Constitutional:
Patient denies chills , fatigue , fever ,
night sweats.
Respiratory:
Patient denies chronic cough ,
shortness of breath , wheezing , pain
with inspiration.
Cardiovascular:
Patient denies chest pain , dizziness ,
irregular heartbeat.
Gastrointestinal:
Electronically signed by CARLOS RAMIREZ RAMIREZ , MD on
Admits Abdominal pain, colicky , diffuse 07/14/2022 at 05:03 PM EDT
, lower abdomen , that is moderate.
Denies Blood in stool.
Admits Change in bowel Sign off status: Completed
habits, diarrhea.
Denies Constipation.
Admits Decreased appetite, beginning with
onset of illness , due to abdominal pain ,
is moderate.
Admits Diarrhea, mixed with
mucous , that is frequent.
Denies Heartburn.
Denies Nausea.
Denies Vomiting.
PMA LSL
Neurologic:
910 OLD CAMP RD
Patient denies dizziness , fainting , STE 130
headache , memory loss , THE VILLAGES, FL 32162-5609
tingling/numbness , loss of strength , Tel: 352-259-2159
gait abnormality.
Fax: 352-674-4384
Progress Note: CARLOS R RAMIREZ-RAMIREZ, MD 07/14/2022
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
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