Current age: 38
Summary of encounters:
The general medical history was completed on July 2, 2008

At the end of last visit, the patient was to be seeing a counselor.
Stress management: working with a counselor.
Since last visit, denies changes in family history.

OTC medications include vitamins.

Prescription medications include Effexor, Xanax.

When asked how they feel, overall, on a scale from 1 to 10, the patient reports "8".

Social history:

Denies changes in marital status.
Occupation change: fired or laid off, stressful but able to handle loss of income and requests help to deal with stress.

Habits:
Non-smoker
Non-drinker
Caffeine use: increasing caffeine intake from last visit, to combat sleepiness.

Gender related hx: Denies menstrual problems. She states that she is using contraception.

Height 62 inches, weight 145 pounds, BMI= 26.5.
According to NHLBI (National Heart, Lung and Blood Institute) classification, the patient's BMI suggests "overweight (BMI 25 to 29.9)". BMI trend: gaining weight. Requests help losing weight. Attributes weight gain to being less physically active lately.

General screening questions:
--- The patient reports a stressful life and sleepiness.
--- Denies dizziness, fevers/chills, feelings of weakness, leg pain or cramps when walking, difficulty sleeping, muscle pain/soreness or muscle weakness.
--- The patient exercises 25 minutes or more per day.

Screening ROS:
Denies chest pain/tightness/pressure/unusual heartbeats/shortness of breath/swelling of ankles, problems with the brain/spine/nerves/other problems with the nervous system, problems with hearing/swallowing/talking/breathing through nose or mouth/ear pain/sinuses/mouth/gums, excessive worry/anxiety/depression/poor concentration/intrusive or repetitive thoughts/memory loss/hallucinations/fears/stressful life, coughing/wheezing/shortness of breath/painful breathing/other respiratory symptoms, constipation/diarrhea/bleeding/black stools/heartburn/nausea/change in bowel habits/loss of appetite/abdominal pain/jaundice/other problems of digestive tract, problems with urination/pai/incontinence/nighttime urination/burning urination/hesitancy/blood in urine/other urinary problems, joint pain/back pain/neck pain/muscle pain/other rheumatological complaints, skin or hair or nail problems/lumps/dryness/rashes, intolerance to heat or cold/sweating for no reason/unusual hair growth/excessive thirst/craving salt/enlarging hat or glove size, easy bruising/prolonged bleeding/enlarged lymph glands or problems with eyes or vision/pain/visual problems/double vision/blurry vision/dry or red eyes. stressful life, Detailed sleep hx:

SLEEP HISTORY:
The patient sleeps 7 out of every 24 hours, on the average.

Monitoring known obstructive sleep apnea: The patient is sleeping in the same bed as bedpartner and bedpartner notices worsening sleep, including tossing and snoring.
CPAP device: currently in use, CPAP/BiPAP was started and patient is using it, patient is not tolerating the CPAP or BiPAP therapy, there are no complaints from bedmate, feeling suffocated or claustrophobic when the device is used, not using the device every night, the CPAP device makes it difficult to sleep, not using the CPAP device every night because they do not like using it, sleepiness has not improved , general health has not changed since starting the CPAP/BIPAP device.
Toleration of the CPAP device: the device causes no chest discomfort, no nose irritation, no nasal drainage with the device, no nosebleeds with the device, denies rashes or skin irritation from the device , denies irritation of the eyes or conjunctivitis.
Notes the device is causing uncomfotable CPAP pressure, trouble exhaling, difficulty sleeping, air swallowing and nasal congestion.

The patient has reported recurrent sleepiness in consecutive visits: being treated for sleepiness but it is not helping.

Patient seeking help dealing with stress and losing weight.

At the end of last visit, the patient was to be seeing a counselor.
Stress management: working with a counselor.
Since last visit, denies changes in family history.

OTC medications include vitamins.

Prescription medications include Effexor, Xanax.

When asked how they feel, overall, on a scale from 1 to 10, the patient reports "8".

Social history:

Patient reports change in occupation.
Denies changes in marital status.
Occupation change: fired or laid off, stressful but able to handle loss of income and requests help to deal with stress.

Habits:
Non-smoker
Non-drinker
Caffeine use: increasing caffeine intake from last visit , to combat sleepiness.

Gender related hx: Denies menstrual problems.

She states that she is using contraception.

Height 62 inches, weight 145 pounds, BMI= 26.5.
According to NHLBI (National Heart, Lung and Blood Institute) classification, the patient's BMI suggests "overweight (BMI 25 to 29.9)". BMI trend: gaining weight. Requests help losing weight. Attributes weight gain to being less physically active lately.

General screening questions:
--- The patient reports reports a stressful life and sleepiness.
--- Denies dizziness, fevers/chills, feelings of weakness, leg pain or cramps when walking, difficulty sleeping, muscle pain/soreness or muscle weakness.
--- The patient exercises 25 minutes or more per day.

Screening ROS:
Denies chest pain/tightness/pressure/unusual heartbeats/shortness of breath/swelling of ankles, problems with the brain/spine/nerves/other problems with the nervous system, problems with hearing/swallowing/talking/breathing through nose or mouth/ear pain/sinuses/mouth/gums, excessive worry/anxiety/depression/poor concentration/intrusive or repetitive thoughts/memory loss/hallucinations/fears/stressful life, coughing/wheezing/shortness of breath/painful breathing/other respiratory symptoms, constipation/diarrhea/bleeding/black stools/heartburn/nausea/change in bowel habits/loss of appetite/abdominal pain/jaundice/other problems of digestive tract, problems with urination/pai/incontinence/nighttime urination/burning urination/hesitancy/blood in urine/other urinary problems, joint pain/back pain/neck pain/muscle pain/other rheumatological complaints, skin or hair or nail problems/lumps/dryness/rashes, intolerance to heat or cold/sweating for no reason/unusual hair growth/excessive thirst/craving salt/enlarging hat or glove size, easy bruising/prolonged bleeding/enlarged lymph glands or problems with eyes or vision/pain/visual problems/double vision/blurry vision/dry or red eyes. stressful life, Detailed sleep hx:

SLEEP HISTORY:
The patient sleeps 7 out of every 24 hours, on the average.

Monitoring known obstructive sleep apnea: The patient is sleeping in the same bed as bedpartner and bedpartner notices worsening sleep, including tossing and snoring.
CPAP device: currently in use, CPAP/BiPAP was started and patient is using it, patient is not tolerating the CPAP or BiPAP therapy, there are no complaints from bedmate, feeling suffocated or claustrophobic when the device is used, not using the device every night, the CPAP device makes it difficult to sleep, not using the CPAP device every night because they do not like using it, sleepiness has not improved , general health has not changed since starting the CPAP/BIPAP device.
Toleration of the CPAP device: the device causes no chest discomfort, no nose irritation, no nasal drainage with the device, no nosebleeds with the device, denies rashes or skin irritation from the device , denies irritation of the eyes or conjunctivitis.
Notes the device is causing uncomfotable CPAP pressure, trouble exhaling, difficulty sleeping, air swallowing and nasal congestion.

The patient has reported recurrent sleepiness in consecutive visits: being treated for sleepiness but it is not helping.

Patient seeking help dealing with stress and losing weight.

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