CHAMPFASTS CC: HPI: PMHx: Meds: Allergies: NKMA FamHx: No family history of heart disease, HTN, DM, lung disease, cancer, thyroid problems SocialHx: EtOH: denied/ current drinker/ quit in ***; # beers daily/ weekly/ monthly; last drink ***; no hx seizures/DTs Tobacco: denied/ current smoker/ quit in ***; # pack-year hx Drugs: denied/ current/ past use SurgicalHx:

Bedside No acute overnight events. Patient seen and examined at bedside this AM.

ROS: GENERAL: no weight changes, fevers, chills HEENT: no headache, vision changes, hearing loss, difficulty speaking/chewing/swallowing, sore throat CARDIAC: no chest pain, palpitations RESPIRATORY: no shortness of breath, cough, wheezing GI: no abdominal pain, nausea, vomiting, constipation, diarrhea, bloody/black stools GU: no frequency, urgency, itching, discharge, hematuria, incontinence ENDOCRINE: no hair loss, intolerance to hot/cold SKIN: no rash HEMATOLOGIC: no easy/excessive bruising MUSCULOSKELETAL: no swelling, arthralgias PSYCH: no anxiety, depression NEURO: no weakness, numbness, vertigo All other systems negative

Physical Exam General: awake, alert, oriented x3, in no distress, cooperative*** HEENT: PERRL, conjunctiva clear, sclera anicteric Neck: supple without lymphadenopathy or thyromegaly Chest: lungs clear to auscultation bilaterally, no rales, rhonchi or wheezes Cardiovascular: regular rhythm, normal rate, normal S1/S2, no m/r/g Abdomen: soft, nontender,nondistended, +bs Extremities: no edema BLE, pedal and radial pulses 2+ and equal bilaterally Musculoskeletal: no swollen or inflamed joints, no joint deformities Skin: warm, dry, well-perfused, no lesions or rashes appreciated Neuro: CN 2-12 intact bilaterally, strength & sensation grossly intact without focal deficits

Neuro Exam - General Mental Status: Alert, oriented x3, no dysarthria, no aphasia, no language deficits Cranial Nerves: II. Visual fields full to finger wave. III, IV, VI: PERRL 2-3mm bilaterally. EOMs: full, no nystagmus. V. Facial sensation intact to light touch & pin prick. VII: Face is symmetric and movements are WNL. VIII: Hearing intact to finger rub. IX,X: Palate elevates symmetrically. XI: Shoulder shrug and head turning are WNL. XII: Tongue is midline Motor: Normal tone. Normal bulk. No pronator drift. Left Right Deltoid (C5,5) 5 5 Biceps (C5,6) 5 5 Triceps (C7) 5 5 Finger flexion (med: C7,8; uln: C8,T1) 5 5 Finger extension (C7,8) 5 5 Hip flexion (L1, 2, 3) 5 5 Hip extensors (L5, S1, 2) 5 5 Knee flexion (L5, S1, 2) 5 5 Knee extension (L3-4) 5 5 Ext Hal Longus (L5-S1) 5 5 Dorsal flexion (L5-S1) 5 5 Plantar flexion (S1-2) 5 5 Reflexes: Left Right Triceps C7 2 2 Biceps C5/6 2 2 Brachioradialis C5/6 2 2 Knee L3/4 2 2 Ankle jerk S1/2 1 1 Babinski S1-L4/5 down down Complex Motor: No resting, postural or intention tremors, no asterixis. Normal alternating hand movements bilaterally, normal finger-to-nose bilaterally, normal heel-knee-shin bilaterally. Gait: Normal base, stride, arm swing. 1 step to turn. Normal heel-toe and tandem gait. Rhomberg test negative, Pull Test negative.

Neuro Exam - Unresponsive Mental Status: Sedated, intubated on ventilator, unresponsive Cranial Nerves: II. Blink to threat present bilaterally III: PERRL 2-3mm bilaterally V, VII: Corneal reflex present VIII: Unable to assess IX,X: Gag present XI: Unable to assess XII: Unable to assess Motor: Normal tone. Normal bulk. Unable to assess strength. Withdraws to painful stimuli BUE and BLE. Reflexes: Left Right Triceps C7 2 2 Biceps C5/6 2 2 Brachioradialis C5/6 2 2 Knee L3/4 2 2 Ankle jerk S1/2 1 1 Babinski S1-L4/5 down down Complex Motor: Unable to assess Gait: Unable to assess

Neuro Exam - Coma Mental Status No response to name call or loud clap With eyes open, does not track or visually attend to examiner or environment Does not follow commands No response to sternal rub Cranial Nerves: No response to bilateral visual threat Pupils ***mm, reactive to light. Spontaneous eye movements present Oculocephalic reflex present bilaterally Corneal reflex present bilaterally Gag reflex present Motor: NML flexor tone in BUE NML extensor tone in BLE No spontaneous movements No voluntary or involuntary movements No withdrawal or response to nail bed pressure in BUE & BLE Reflexes: Right Left Biceps 2 2 Brachioradialis 2 2 Quadriceps 2 2 Achilles 2 2 Ankle clonus Absent Absent Babinski Down Down Sensation: No grimace/response to deep nail bed pressure in BUE & BLE

FEN Diet: NPO pending Fluids: as clinically indicated Eletrolytes: replete as clinically indicated DVT Prophylaxis: SQ heparin/ Lovenox GI Prophylaxis: None Disposition: Appropriate for floor Isolation: None Code status: Full code Patient seen and examined and will be discussed with attending physician, Dr. ***.

Screening Colonoscopy: Lipid panel: AAA screening: PSA: HepC screening: Mammogram: Dexa scan: Pap smear: Low-dose chest CT/ Lung CA: Diabetes HbA1C: ACE/ARB: Statin: Foot exam: Urine microalbumin: Eye exam: