100 Marshall Lane Springfield VA 22153 US Nikolai Bellic 1400 Main Street Ste G Springfield VA 22150 US Raymond Boccino MD 1400 Main Street Ste G Springfield VA 22150 US Mallory Bardas RN Primo Adult Health 1400 Main Street Ste G Springfield VA 22150 US Bernard Crane MD Springfield Geriatric Associates 202 County Line Rd Springfield VA 22150 US 1400 Main Street Ste G Springfield VA 22150 US Raymond Boccino MD 100 Marshall Lane Springfield VA 22153 US Kathleen McReary 209 County Line Rd Springfield VA 22150 Dwayne Forge MD 1400 Main Street Ste G Springfield VA 22150 US Raymond Boccino MD 1400 Main Street Ste G Springfield VA 22150 US Raymond Boccino MD Primo Adult Health 1400 Main Street Ste G Springfield VA 22150 US Primo Adult Health 1400 Main Street Ste G Springfield VA 22150 US

No advance directives exist for this patient.

Allergy to Penicillin drugs Allergy to Bee Pollen

Recent falls

Non-contributory

Difficulty remembering dates. Patient uses cane for walking.

Influenza, seasonal, injectable, preservative free Influenza Vaccine Company

Patient is to schedule follow-up appointment with PCP after consultation.

Lisinopril - 20mg by mouth once daily Lasix - 40mg by mouth once daily K-Dur - 10mEq/L by mouth once daily Norvasc - 10mg by mouth once daily Zocor - 40mg by mouth once daily before bed Lantus - 36 units once daily before bed gliburide - 2.5mg by mouth once daily synthroid - 0.1mg by mouth once daily Aleve - 220mg by mouth twice daily Ultram - 50mg by mouth four times daily as needed for joint pain Aspirin - 81mg by mouth once daily Lopressor - 50mg by mouth twice daily Flomax - 0.4mg by mouth once daily Proscar - 5mg by mouth once daily Neurontin - 300mg by mouth three times daily Ativan - 1mg by mouth three times daily as needed for irritability miodarone - 200mg by mouth two times daily Coumadin - 5mg by mouth every other day starting 11/1/2012 Coumadin - 2.5mg by mouth every other day starting 11/2/2012 Ambien - 5mg by mouth once daily before bed Take as needed for joint pain Take as needed for irritability

I have discussed this request for geriatric assessment and management with the patient who agrees with this plan.

Hypertension Hyperlipidemia Type II Diabetes Chronic Kidney Disease Stage III Hypothyroidism Coronary Artery Disease Benign prostatic hyperplasia Atrial fibrillation Diabetic neuropathy Generalized obesity Insomnia

EKG (2012/10/15) Cholecystectomy (2006/06/01) Cataract Removal (2004/02/01) Angioplasty with Stent Placement (2002/08/01) Coronary Bypass (1997/11/01) Total Knee Arthroplasty (1997/03/01) Tonsillectomy (1944) 209 County Line Rd Springfield VA 22150 Dwayne Forge MD Open Heart Associates 209 County Line Rd Springfield VA 22150 422 County Line Rd Springfield VA 22150 Philip Bell MD Digestive Associates 422 County Line Rd Springfield VA 22150 310 County Line Rd Springfield VA 22150 Marybeth Choy OD Vision Institute 310 County Line Rd Springfield VA 22150 209 County Line Rd Springfield VA 22150 Dwayne Forge MD Open Heart Associates 209 County Line Rd Springfield VA 22150 209 County Line Rd Springfield VA 22150 Dwayne Forge MD Open Heart Associates 209 County Line Rd Springfield VA 22150

Geriatric assessment and management for concerns about dementia and falling

TSH - 6 m[IU]/L (abnormal, high alert) Hgb a1c - 8% (abnormal, high alert) Creatinine - 1.5 mg/dL (abnormal) INR - 3.5 (abnormal, high alert) Echo EF - 55% (normal) Aortic Valve - 1.5 cm2, Stage II diastolic dysfunction (abnormal) EKG Impression - EKG rate 60s, A fib, LBBB normal: 0.29–5.11 IU/ml normal: 4.0-5.6% normal: below 1.5 mg/dL Normal reference range 1.0-1.5; Targeted INR 2.0-3.0 Normal: 50-75% Normal (3.0-4.0 cm2), mild (1.5–2.0 cm2), moderate (1.0–1.5 cm2), severe (less than 1.0 cm2) EKG rate 60s, A fib, LBBB

50 pack year smoking history, quit 1997 etoh (alcohol) daily, patient reports varies from 1 to many cocktails per day denies sexual activity due to impotence retired corporate executive

Vitals Normal: Height - 70 in (normal) Weight - 220 lb_en (normal) BMI - 31.56 kg/m2 (normal) BP Systolic - 175 mmHg (normal) BP Diastolic - 90 mmHg (normal) Heart Rate - 90 mmHg (normal) Body Temp - 97.9 degF (normal)