Outpatient Clinic Attendance


					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
							normal
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
							abnormal
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
							
								
								
								
								
									
									
									
										
											
										
									
									
									
										
									
									
								
							
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
						
					
					
					
						
						
							
							
							
								
									
								
								
									
									
								
							
							
							
							
								
								
									
									
										
										
									
								
							
							
								
								
								
									
								
								
									
									
									
									
									
										
										
											Mr
											David
											Wilkinson
										
									
								
							
							
								
								
								
									
									
									1 per day
								
							
							
								
								
								
									
									
									
									
										
									
								
							
							
								
								
								
									
									
									
								
							
						
					
					
					
						
						
							
							
							
								
									
								
								
									
									
								
							
							
							
							
								
								
									
									
										
										
									
								
							
							
								
								
								
									
								
								
									
									
									
									
									
										
										
											Mr
											David
											Wilkinson
										
									
								
							
							
								
								
								
									
									
									1 per day
								
							
							
								
								
								
									
									
									
									
										
									
								
							
							
								
								
								
									
									
									
								
							
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
						
					
					
					
						
						
							
							
							
								
									
								
							
							
							
								
							
						
					
					
					
						
						
							
							
							
							
						
					
					
						
						
							
							
							
							<text>
								<table>
									<tbody>
										<tr>
											<td colspan="1" rowspan="1">
												<content styleCode="Bold">Organisation:</content>
											</td>
											<td colspan="1" rowspan="1">Lancashire Hospital Trust</td>
										</tr>
									</tbody>
								</table>
								<paragraph />
								<table>
									<tbody>
										<tr>
											<td colspan="1" rowspan="1">
												<content styleCode="Bold">DATE OF ARRIVAL:</content>
											</td>
											<td colspan="1" rowspan="1">05-May-2006 14:00</td>
										</tr>
										<tr>
											<td colspan="1" rowspan="1">
												<content styleCode="Bold">DATE OF LEAVING DEPARTMENT:</content>
											</td>
											<td colspan="1" rowspan="1">05-May-2006 16:20</td>
										</tr>
									</tbody>
								</table>
								<paragraph />
								<table>
									<tbody>
										<tr>
											<td colspan="1" rowspan="1">
												<content styleCode="Bold">Date Document Sent: </content>
											</td>
											<td colspan="1" rowspan="1">05-May-06 16:45</td>
										</tr>
									</tbody>
								</table>
								<paragraph />
								<table>
									<tbody>
										<tr>
											<td colspan="1" rowspan="1">
												<content styleCode="Bold">Hospital</content>
											</td>
											<td colspan="1" rowspan="1">St. Elsewhere’s Hospital</td>
										</tr>
										<tr>
											<td colspan="1" rowspan="1">
												<content styleCode="Bold">Senior Physician: </content>
											</td>
											<td colspan="1" rowspan="1">Dr. Harry Pollock</td>
										</tr>
									</tbody>
								</table>
							</text>
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								<section classCode="DOCSECT" moodCode="EVN">
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									<title>Reason for Referral
									
										Crushing central chest pain on exertion. Lasts for 5 minutes relived immediately by GTN. 6 occurrences in the last 2 weeks.
								
							
							
								
								
									
									
									Relevant History
									
										Previously fit and well. Smoker average of 15 per day since 1956
Father died of heart attack at age 52 (in 1949).
									
								
							
							
								
								
									
									
									Findings on Examination
									
										Blood Pressure 140/85
									
								
							
							
								
								
									
									
									Investigation Results
									
										
											
												
													
														Investigation
													
													
														Results
													
												
											
											
												
													
														Standard Chest X – ray
													
													Normal
													
												
												
													
														Standard ECG
													
													Normal
															
												
												
													
														Exercise ECG
													
													Abnormal - significant ischaemic changes in antero-lateral leads.
												
												
													
														Full Blood Count
													
													
												
												
													
														- Haemoglobin level
													
													13.2g/dl
												
												
													
														- White Cell Count
													
													4.5x10⁹/l
												
												
													
														- Platelets
													
													254x10⁹/l
												
												
													
														Urea and Electrolytes
													
													
												
												
													
														- Sodium
													
													133mmol/l
												
												
													
														- Potassium
													
													4.0mmol/l
												
												
													
														- Bicarbonate
													
													28mmol/l
												
												
													
														- Urea
													
													3mmol/l
												
												
													
														- Creatinine
													
													50micromol/l
												
												
													
														- Chloride
													
													101mmol/l
												
											
										
									
								
							
							
								
								
									
									
									Diagnosis
									
										Exertional angina
									
								
							
							
								
								
									
									
									Medications
									
										
											
												
													
														Item
													
													
														Dose
													
													
														Supplied
													
													
														Notes
													
												
											
											
												
													
														Aspirin 75mg dispersible tablets
													
													1 per day
													7 tablets
													To be continued
												
												
													
														Atenolol 50mg tablets
													
													1 per day
													7 tablets
													To be continued
												
											
										
									
								
							
							
								
								
									
									
									Follow on Plan
									
										
											Chest pain advice leaflet given and explained
											Smoking advice given
											
												Cardiac Angiography – scheduled for 2 weeks hence (20-May-06 10:00)
											
											
												Fasting glucose (booked for following day - 06-May-06 11:20)
											
											
												Fasting Lipids (booked for following day - 06-May-06 11:20)
Investigation	Results
Standard Chest X – ray	Normal
Standard ECG	Normal
Exercise ECG	Abnormal - significant ischaemic changes in antero-lateral leads.
Full Blood Count
- Haemoglobin level	13.2g/dl
- White Cell Count	4.5x10⁹/l
- Platelets	254x10⁹/l
Urea and Electrolytes
- Sodium	133mmol/l
- Potassium	4.0mmol/l
- Bicarbonate	28mmol/l
- Urea	3mmol/l
- Creatinine	50micromol/l
- Chloride	101mmol/l
Item	Dose	Supplied	Notes
Aspirin 75mg dispersible tablets	1 per day	7 tablets	To be continued
Atenolol 50mg tablets	1 per day	7 tablets	To be continued