Which of the following uses the UB-04 claim form? MICROSCOPIC: Consists of a portion of female breast tissue in which is located an infiltrating ductal carcinoma of the breast. An end-to-end anastomosis was completed on both segments. The patient should wait about two to three weeks, and then he should start using Aldara cream on all of the warts q.h.s. He does have some pain on palpation of the lateral shoulder. PAST MEDICAL HISTORY: The patient states that she is otherwise healthy. The digital nerves were identified to the long finger and the AI pulley was released in its entirety to the long finger. Insertion of VVI pacemaker. PLAN 1. Will increase his Zantac to 300 mg b.i.d. Tinnitus was diagnosed last year. When more than one laboratory test is performed on the same day, it is appropriate to append modifier 51 to the additional laboratory tests. This was debrided back at the bedside to healthy granulation tissue at his first consultation. The esophageal mucosa was normal in the proximal, mid, and distal portions. A patient presents to the emergency room with an ankle sprain received when he fell while skateboarding. Extraocular muscles are intact. A preliminary report was called by the ultrasound technologist to the referring physician. t.i.d. No thyroid gross abnormality. Using the snare technique the polyps are removed. NECK: The trachea was midline. There was no localized tenderness, masses, bruits, or organomegaly present. Follow up in 1 week for a second Synvisc injection. A limited PET scan of the chest is performed. Anesthesia of 2% lidocaine with epinephrine was infiltrated circumferentially around the previously marked swelling. The apex was cut with the laser, and the specimen submitted. should check residents'skin each time they are repositioned. Which is true about nursing assistants and catheters? He continues to smoke. A covered entity must provide access to PHI in the manner requested by the individual. Since this time he has been undergoing wet-to-dry dressing changes b.i.d. The patient denies chest pain, palpitations, or syncope. Patient is a 34-year-old obese white male who was evaluated for obstructive sleep apnea, nasal septal deviation, and tonsillar hypertrophy. We have discussed condom use and post care with liquid nitrogen to avoid any frictional or irritational activity to this site. Careful longitudinal dissection was carried out. He comes in today for re-evaluation. A resident's proteced health information (PIH) may be shared with: only those who need the information for care or processing of records. The patient is seen in the clinic for chronic sinusitis. He is currently taking verapamil SA 120 mg p.o. The cervix was painted with 4% acetic acid and the area of abnormal epithelium was visualized. A 45-year-old female patient is seen for chemotherapy to treat metastatic carcinoma of the spinal column. What is the correct conversion of 4:10p.m. The patient has a new 90-day supply. She has had good result and no problem from the surgeries or anesthesia in the past. A 68-year-old male patient is seen in the Radiation Oncology Department at the hospital for secondary prostate cancer. If a resident with Alzheimer's disease has problems with dressing, the nursing assistant should: lay out clothes in the order they should be put on, Durable Power of Attorney for Health Care. Normal range of motion. A sterile dressing was applied along with a metal protective cup to protect the zygomatic arch. Aide / FAQ; Conditions générales de vente The endoscope was withdrawn out of the distal stomach and retroflexed for a view of the lesser curvature, which was normal. The patient has been divorced for three years and currently lives by himself in _____[PLACE], and he has three children, all sons. What is something a nursing assistant needs to observe and report regarding the musculoskeletal system: white, shiny, red, or warm areas over a joint. Adjacent epidermis is hyperplastic. Which department would assist this patient? EARS/NOSE/MOUTH/OROPHARYNX: Without abnormality. Lower uterine incision was created with sharp scalpel and infant delivered in breech presentation without any difficulty. Ears were without lesions or deformities. He has been doing quite well on this but says he started having upper respiratory tract symptoms last week and says he has become more short of breath. Depression. Billing for two or three codes when one comprehensive code is more appropriate? The needle was inserted into the subclavian vein and after many trials; satisfactory placement of the needle in the subclavian vein was obtained. On inspecting his perineum, he has a large anal tag. Which of the following is true about a patient's rights related to accessing and managing their protected health information (PHI)? No evidence of muscle rupture. MEDICATIONS: Never used Phen-Fen. Under IV sedation the patient was placed in the supine position. A 12-year-old child was brought into the emergency room because of a large mass on the left side of the neck. The scope was retroflexed. What is one good way a nursing assistant can assist residents with normal changes of aging related to the urinary system? Endocervical curettage; endometrial curettage with cervical dilation. The patient has hypercholesterolemia, as well as tinnitus. Free Porn and XXX sex videos on the Porn paradise Cumlouder: sex and pussy videos to download or to watch on streaming. for his COPD exacerbation. LUNGS: There is wheezing bilaterally. Part two demonstrates two lymph nodes positive for carcinoma. ASSESSMENT/PLAN 1. As the scope was withdrawn, a very small 2 mm polyp was seen at the hepatic flexure and removed with a snare. CHEST: The lungs are clear to auscultation bilaterally. His sleep study revealed his condition is severe with a high sleep hypopnea index. What is the term for a device that replaces a missing body pat? Complaints are none other than some appropriate postoperative tenderness. The stomach itself insufflates well, with only mild gastritis as the only finding. PHYSICAL EXAMINATION: The ABDOMEN is soft. Chronic obstructive pulmonary disease. She now has completed chemotherapy and an assessment of treatment response is requested prior to surgical resection. The physician decides to perform an endoscopic sinus surgery. Patient in no apparent distress, alert and oriented x 3. Toy dolls for the patient and the use of an interpreter were required. ABDOMEN: Soft, nontender, and bowel sounds are present. A 28-year-old female patient presents to the ambulatory surgery center to have a minor procedure performed. Draping was applied. In the deeper intertrabecular space, there is fibrosis and minimal chronic inflammation and focal necrosis with a few degenerated neutrophils. However, the mitotic rate is less than 1 mitosis per 10 high power fields. This is the patient's initial visit. The pathology report came back four days later showing the mole was benign. The pedicle of the lipoma was transfixed and ligated. The procedure was performed and the patient tolerated it well and was sent to the ICU for airway maintenance. The last one was in ____[DATE] with total cholesterol of 198, triglycerides 124, HDL 59, LDL 113. Health records for minors should be retained until the patient_____. Where should the call light be placed when a nursing assistant leaves a resident's room? Code as if the physician were providing the above services only. The oncologist, who is an employee of the hospital, performs complex clinical treatment planning, basic dosimetry calculation, and a complex isodose plan; treatment devices include blocks, special shields and wedges. Fred, a 34-year-old male, fell from a 4-foot scaffolding and hit his heel on the bottom rung of the support. No dullness on percussion. Tobacco dependence. Normal gait. EYES: Pupils are equally round and reactive to light. What is the anesthesia code? He had some mildly generous hemorrhoidal vessels, but otherwise no pathology encountered. SOCIAL HISTORY: Nonsmoker, nondrinker. Following this, a screening colonoscopy was performed to the ileocecal valve without difficulty. Joking with a resident's roommate about the resident's incontinence is what type of abuse? Where is the best place for Ben to look for this information? The patient is here for a follow up of his nonhealing left great toe ulcer. A code designated as a separate procedure can be reported by itself, or under certain circumstances, in addition to other procedures or services. Manhattan Wellness Group has a great team of Chiropractors for the evaluation and treatment of Lower Back Pain, Neck Pain, Shoulder Pain, Knee Pain, Sciatica Pain, Pinched Nerve, Herniated Disc, Elbow Pain, Joint Pain, Bulging Disc, headaches or Breech Baby … 6h. The skin, soft tissue and bone at the surgical margin grossly appear viable. When using a transfer belt, the NA should. The process of clarifying conflicting, ambiguous, or incomplete information contained in the patient's medical record. Pedal pulses are palpable bilaterally. She is 5 foot 5 inches. The incision is clean, dry, and intact with no signs of erythema or other signs of infection. What is an example of a normal change of aging? Donna, a 41-year-old female patient presents to the outpatient surgery department for biopsies of both breasts. Here are some helpful navigation tips and features. There is stool present in the vault; however, there is no gross blood present on examination. Uterine incision was closed with 0 chromic running locking fashion and figure-of-eight suturing. What is one important reason why the bed should remain wrinkle-free? The first container is further labeled "right breast wide excision" and consists of a piece of fibroadipose tissue with a small skin ellipse extending off to the medial side of the specimen. LUNGS: The patient has some inspiratory rales as well as coarse expiratory wheezes. Vital signs reveal a blood pressure of 140/89, weight 202 pounds, pulse 72, temperature 95. 2. 6. He had fallen off the ladder at home and hurt his ankle. REVIEW OF SYSTEMS: Negative other than hay fever and hernia mentioned above. The urinalysis revealed gross hematuria. Upon examination the patient was normal with the exception of caput succedaneum secondary to sitting in the birth canal for so long. Assessment: urinary tract infection, intractable migraine with status migrainosus, and acute maxillary sinusitis. b.i.d., ibuprofen 800 mg p.o. The hernia does not stay reduced when reducible and it does become, by her description, incarcerated at times. The cervix was then dilated with Hank dilators to #20. The pacemaker electrode was inserted and passed down into the right ventricle with a curved stylet. Under general anesthetic an incision was made over the anterior wall of the inguinal canal, which was opened. REVIEW OF SYSTEMS: The health summary has been completed and is part of the medical record (which shows a complete SH, FH, and PMH as well as a complete ROS), and is positive for posttraumatic arthritis of the right fifth little finger and elbow, secondary to old trauma. There are no crackles or rhonchi. The bladder had previously been straight cathed and emptied. Penile warts. What is a good way for a nursing assistant to care for a mentally ill resident? Take A Sneak Peak At The Movies Coming Out This Week (8/12) Soundtrack Sunday: The 2021 Grammy Awards Nominees Playlist The patient is in apparent pain, and the ankle has begun to swell. Which of the following is true of Transmission-Based Precautions? PLAN: Magnesium citrate one bottle to be drunk when he gets home. Copious amount of irrigation was used. He has venostasis changes in his bilateral lower extremities. Compteur en temps réel de la dette de la France 2021. Her oxygenation has been good, always at 95-96%. The patient is presenting with swelling of a long duration over the front of the neck and desires excision. Administration of oral and/or rectal contrast alone qualifies as a study with contrast. She does have a periumbilical hernia, which has gotten worse. A prescription was given to the patient. What is a good way for a nursing assistant to respond to inappropriate sexual behavior? The patient was placed on the operative room table in the supine position and general endotracheal anesthesia was administered. The parents elected to have surgery performed. Which member of the care team diagnoses disease and prescribes treatment? EXAM shows pain with abduction or extension both passive and active. IMPRESSION 1. 534 Likes, 9 Comments - University of Rochester (@urochester) on Instagram: “Rochester graduate Emma Chang ’20 is a classically trained musician. He was prepped and draped in the usual fashion. Patient comes into the office with a chief complaint of right wrist pain and right ankle pain. We will schedule pulmonary function tests with and without bronchial dilators. ALLERGIES: ALLERGIC REACTION TO ROBITUSSIN, otherwise no allergies. The exam was intermediate. Bowel sounds are present. A weighted speculum was placed into the vagina, and a tenaculum was used to grasp the anterior portion of the cervix. If one side of a bilateral condition has previously been treated, and the condition no longer exists on that side, for the current visit, assign the appropriate unilateral code for the side where the condition still exists. The final pathology report confirmed adenocarcinoma of the stomach metastatic to the liver. You always start in the Tabular List when locating and assigning diagnosis codes. Part two: Axillary tissue received fresh is a specimen of fibrofatty tissues measuring 4 x 3 cm in aggregate. H91.90, H93.19, M12.59, J44.9, F17.210, Z91.030, 99203. She has been tried on a Z-Pak as well as a short course of Levaquin earlier in the month, and did seem to get better for a period of time. Both masses were removed and specimens sent to pathology. HEENT: This patient is normocephalic. Start studying Professional Medical Coding and Billing Final Exam. The aorta bifurcates into the _____________. 2. He has lost 12-15 pounds in the last 10 days and reports difficulty swallowing meals. Code the anesthesiologist services: Sal, an 81-year-old patient with a mild systemic disease received anesthesia for a revision of a total hip arthroplasty. WDWN, regular pulse, R.R., afebrile, HEENT: Head atraumatic, normocephalic. 4. Which term describes a medication placed in the mouth next to the cheek? The stone in the upper right kidney was positioned at F2. Extraocular movements were intact. They are all listed in history exam on her chart. There were no discreet rales, wheezes, or rhonchi apparent. What modifier would Dr. Torres append to CPT® code 73590 for his services? The patient first noticed it as a nurse practitioner for this problem in _____[DATE]. A review of the medical record to determine its completeness. At this point, patient was repositioned and a colonoscopy performed. Add-on codes are reported when the same physician or a different physician performs a procedure or service. Patient has a 98% saturation on room air. In the center of the specimen is a firm area measuring 1 x 2 cm. NAs observe and report regarding catheters. The patient has an EMS and heating plan at the ___[HOSPITAL]. National Center for Health Statistics (NCHS). it could be the beginning of a pressure sore. Generally, the last sense to leave a dying person is the sense of. The lipoma measured 4.5 cm. Complete right shoulder x-ray shows no dislocation or fracture of his shoulder joint or humerus. Tempo Santé - Offre spéciale 5 numéros (16 à 20) Nos moyens de paiement. The specimen is decalcified and representative sections are submitted. The patient was taken to the operating room and placed in the supine position. Which of the following is true in regard to the release of protected health information (ROI)? A margin 5 mm outside of the dissected area was bladed down to the depth of 3 mm. The pressure obtained in this position was excellent. ALLERGIES: THE PATIENT HAS NO MEDICATION ALLERGIES, BUT HAS A SIGNIFICANT BEE STING ALLERGY HISTORY, AS NOTED IN THE REVIEW OF SYSTEMS. The pacemaker took over the pacing thereafter. The patient is alert and oriented x 3 in mild distress. Following a course of Solu-Medrol and Combivent, her air movement improved significantly and she felt much better. A 51-year-old patient presents with a history of invasive ductal carcinoma of the left breast. Acinetobacter baumannii complex is a Gram-negative coccobacillus that is oxidase-negative, indole negative, catalase positive, and exhibits twitching motility in wet mount, though it is nonmotile in motility agar. Peritoneum entered bluntly and incision extended superiorly and inferiorly. q.d., albuterol, Paxil, multivitamins, and Flovent inhaler. On discharge his final diagnosis is suspected paroxysmal supraventricular tachycardia. The patient is a 72-year-old male who suffered an adverse reaction of hives after starting to take the new prescription of Triamterene his physician prescribed three days ago. The form she is reviewing includes CPT codes and Jane must determine which diagnosis each procedure was intended to treat. Trachea is midline. There is beefy granulation tissue at the bed of the majority of the ulcer. PLAN 1. The pacemaker was connected and the pacemaker electrode was sutured to the pectoral tissue with two 2-0 silk sutures. A 42-year-old male patient with AIDS, presents to the Emergency Department for treatment of an open fracture of the acromial end of the right clavicle. The single most important thing you can do to prevent the spread of disease is to. In order for a facility to receive federal healthcare funding (Medicare and Medicaid), they must comply with regulations called: After suffering a stroke, a patient requires therapy to assist in performing activities of daily living such as getting dressed and cooking. 54 Likes, 13 Comments - Residents (@lapmrresidency) on Instagram: “Resident’s Corner: Name: David Huy Blumeyer, MD Year in residency: PGY-4 Where were you born…” Because of continued problems with chronic tonsillitis; he also planned a tonsillectomy and adenoidectomy to be performed the same day. Standing with the legs shoulder-width apart is using, Aftr an amputation, a resident may experience phantom sensation. HEART: Regular rate and rhythm without murmur. LYMPHATICS: There are no palpable, cervical, supraclavicular, or epitrochlear nodes present. The child was taken to the operating room and prepped in the usual fashion. The foramen magnum allows the passage of _________ into the skull. When assigning Emergency Department Services E/M codes, there is a distinction made between new and established patients. A total of 2,400 shocks were delivered with apparent adequate fragmentation obtained. The hernia is reducible. A skin crease incision was fashioned over the swelling and deep into the platysma until the capsule of the lipoma was reached. No recurrent hernia appreciated on physical exam. I would like to have a fasting lipid panel, basic metabolic panel, and thyroid panel done with his next visit and a chest x-ray today to rule out pulmonary infiltrate. Which of the following is a payment methodology under OPPS that uses a coding and reimbursement hierarchy to pay for hospital outpatient services? nursing assistants must have at least 75 hours of training. Vital signs: Blood pressure 124/79, pulse 88. Extracorporeal shockwave lithotripsy of right kidney stone. The physician performs and interprets a left ankle x-ray 2 views. PLAN: We will give her Levaquin 500 mg q.d. Click to see our best Video content. Complete shoulder x-ray shows no dislocation or fracture of his right shoulder joint or humerus. He is unable to flex the ankle. Add-on codes are exempt from the use of modifier 51. There was no evidence of diverticula. No other pathologic finding as the scope was withdrawn towards the rectum. Calculating speed and efficiency of healthcare providers' claims submission. We will order a swallowing study as well as chest x-ray. It is a non-fermenter on MacConkey agar but some strains are partial lactose-fermenters. This 56 yr. old male patient has been complaining of chest pain off and on for several weeks. Which of the following is a requirement of OBRA? Report the physician service. The patient had numerous lesions treated today with liquid nitrogen for two freeze/thaw cycles for five to ten seconds to all. The patient was taken to the recovery room in stable condition. This patient has been treated for Crohn's disease of the small intestine. A ___________ is the permanent and painful stiffening of a joint and muscle. He has had it for a number of years. OBJECTIVE: Vitals per electronic progress note. Cord blood was obtained. The patient tolerated the procedure well and we will be follow up in the office. EXTREMITIES: Within normal limits. Each of these wounds required intermediate closure. When a second physician other than the health care professional providing the diagnostic or therapeutic services provides moderate conscious sedation in a facility setting, the second physician reports the moderate conscious sedation procedure. There are areas of fibrosis towards the inferomedial and deep areas of the specimen. Sarah, a 40-year-old female new patient was seen in the clinic by Dr. Izzy Stevens for fever, flank pain and blood in the urine. The fascia was explored and dissected off the rectus muscle. Infiltrating ductal carcinoma of the breast, Grade II 2. Consultation SUBJECTIVE: This patient is new to me and has had a chronic cough since ____[DATE] of last year. I gave him enough for six nights on a trial basis since he is diabetic. She was taken to the operating room and prepped and draped in a sterile manner following general anesthesia with mask ventilation. Gamer.no er Norges viktigste og beste nettsted for data- og videospill. A plastic drape was placed on the wound area. A bulky hand dressing was applied, and she was taken to recovery in good condition. We then directed our attention to the ring finger. Based on the table below, what is the facility's expected reimbursement? The superficial temporal fascia was reapproximated using interrupted 4-0 Monocryl sutures. After reading and interpreting the x-ray, Dr. Torres determined the boy had a fractured left tibia/fibula. What member of the care team might help a resident learn to use adaptive devices for eating or dressing? With whom may a nursing assistant share a resident's medical information? Emergency Department Report SUBJECTIVE: The patient is a 63-year-old female who has had problems with intermittent productive cough, as well as a chronic irritative cough, which has been present here for at least 3 months off and on. Evaluation and Management codes are submitted for physicians to receive reimbursement for their services. During the exam Dr. Grey also performed a urinalysis dipstick, automated with microscopy and a 12 lead EKG. Which position is a resident in if he is lying on his stomach? When the physician documents use, abuse and dependence of the same substance, only the code for dependence is reported. The patient will return for acute problems prior to his primary care physician appointment. The patient has also been advised to return to the emergency room if his condition worsens. Denies headaches or syncope. The scope is advanced to the sigmoid colon and total of three polyps are found. The patient had a raised mole under her right breast that is continually irritated from her underwire bra rubbing on it and causing it to bleed. REASON FOR CLINIC VISIT: Status post one week left inguinal hernia repair "open." She has had several exacerbations but has been maintained on drug therapy. What should a nursing assistant do each time a patient is repositioned? No tenderness in the muscle. I told him to wear the sling for comfort, but to make sure he maintains range of motion in the shoulder. Minimal blood loss. HISTORY OF PRESENT ILLNESS: This new patient has had some tinnitus and some chronic hearing loss for 30+ years. There is no stricture. A 54-year-old male patient with suspected carcinoma of the stomach was admitted to the hospital's outpatient surgery department for an exploratory laparotomy. The wound was dry at the time of the insertion of the pacemaker. There was no JVD or lymphadenopathy present. He was scheduled for a UPPP, nasal septoplasty, and tonsillectomy. The primary site was the lower lobe of the lung. Which of the following is NOT a prefix meaning lungs? Which of the following is used when documenting the amount of fluid a resident drinks? The patient was extubated and transferred to the recovery room in stable condition. Oh no! The legal process lawyers use to obtain information regarding all aspects in a case. Which of the following is another name for outpatient care? Which of the following directional terms means Nearest; closer to the center of the body or point of attachment to the body? There is no clubbing, cyanosis, or edema noted. The patient is a 32-year-old female patient with a family history of malignant neoplasm of the breast who is seen today for a screening mammogram which revealed microcalcifications of the right breast. This patient is seen today with a diagnosis of degenerative arthritis of the left knee. The patient was then prepped and draped in the normal sterile fashion. The patient was then taken to the recovery room in stable condition. In the soft tissue of the subcutaneous area is a focus of fibrosis containing deposits of amorphous material surrounded by histiocytes, foreign body giant cells and few lymphocytes. Bee sting allergy. He states that he does not get as short of breath but has frequent throat clearing and globus sensation. The gastric mucosa was normal passed through the pylorus to the second portion of the duodenum. Selective debridement down to the level of the bone was done to remove fibrinous exudate at the base of the wound. PULMONARY: Respirations slightly decreased. Pathology Report SPECIMEN: A. His mom took him to see Dr. Torres, who sent the mother and her son to a hospital to have an x-ray of the left tibia/fibula taken. The hernia is reducible. 5 foot 5 inches and 165 pounds. Which of the following will be used to bill for the room and board he received during his admission? ... What is the medical term for high blood pressure? Bivalve speculum was placed in the vagina and the cervix visualized. Exercises that put each joint through its full arc of motion are called: What is the medical term for high blood pressure? The final step of the healthcare reimbursement process begins____. PHYSICAL EXAMINATION: GENERAL: This patient is alert, cooperative, and in no acute distress. There is a fetal pole measuring 7 mm, consistent with 6 weeks 4 days. Subcuticular Vicryl was applied, and subsequently Steri-Strips were applied to the skin. What is one way a nursing assistant can promote a resident's independence? The physician performed a urinalysis with microscopy, and a 2 view paranasal sinus x-ray. The cord was isolated taking care to preserve the nerve. Right Female Breast Wide Excision B. Axillary lymph node biopsy GROSS DESCRIPTION: Specimen is received fresh in two containers each labeled with the patient's name and hospital number. Learn vocabulary, terms, and more with flashcards, games, and other study tools. When multiple procedures (other than E/M services, physical medicine and rehabilitation services, provision of supplies, or add-on codes) are performed at the same session, by the same individual, the additional procedure or service is identified by appending modifier 51 to the additional procedure or service code(s). The patient will be reviewed in the Outpatient Clinic in 3 days time. pain is a different experience for each person, check the resident's skin daily and report changes. other staff members involved in the resident's care. There was also a mass noted on the liver. The left knee was drained of 60 cc of non-inflammatory fluid followed by injection of 1 mg of Synvisc. CARDIOVASCULAR SYSTEM: Revealed regular heart rate without murmur or gallop. SOCIAL HISTORY: This patient is married. Epidural anesthesia was dosed. The patient was taken to the operating room where the orthopedic surgeon manipulated the bone pieces back into position and secured the fracture sites by means of percutaneous fixation. SKIN: No visual or palpable gross irregularities on areas examined. Pus and fluid was drained from the abscess. I gave him an arm sling to wear for comfort. An individual psychotherapy session is provided to three-year-old Holly, who is deaf. CV: No gross edema, or significant varicosities. The physician inserts a flexible scope into the patient's rectum and determines the rectum is clear of any polyps. In addition, on review of systems: THE PATIENT IS ALLERGIC TO BEES. Examination of his ulcer today shows a very well taken care of ulcer. The scope was then withdrawn without further pathologic findings. Denies shortness of breath or wheezing. A 36-year-old male patient came into the orthopedic surgeons' office 3 days after being in the emergency room. Histologically the tumor is 2mm from the inked margin. This will help his system to fight off and cause the warts to regress. HEART: Regular rate and rhythm without murmur. MUSCULOSKELETAL: Generally unremarkable. She has taken her migraine medicine with no relief. The patient tolerated the procedure well and without apparent complications. He is contacted by Mr. Allen's insurance company who wants to know the admit and discharge dates for Mr. Allen's most recent admission to the hospital. A 43-year-old female established patient comes into the office today with complaints of a fever, productive cough for the past 3 days. Progress Note CHIEF COMPLAINT: Hearing loss and chronic tinnitus. Denies PND or orthopnea. p.r.n., simvastatin 20 mg q.h.s. As the scope was withdrawn back into the stomach, it was retroflexed and again the hiatal hernia was apparent.
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