Test 1 of 25

OET Writing mock test 1 – Updated

OET Writing sample test 1

OET Writing sample test 1 for doctors
OET Writing sample test 1 for doctors

Welcome to a new OET writing sample test 1 for doctors from OET2.com.

You will have 5 minutes to read the letter and 40 minutes to write your answer.

We do not guarantee a free correction of letter, but we will do our best to evaluate it.

Please wait for few seconds after stating the test for the file to be uploaded

Tips to write a band A OET writing Letter

How to write the Introduction of the OET Letter?

  1. Date & Address

The position of the date can be either above the address or below the address. It is normal to leave a blank line space between the date and address. (But don’t write both above and below.)

Date (this position is acceptable)
Name of person or Doctor
Address
Address
Date (this position is also acceptable)

  • In formal letters, it is normal for the date at the start to be written in full form e.g. 3rd February 2018 rather than 02/02/18. [Numbers and slashes is fine within the body of the letter]
  • The test materials are specifically written for the test date each month so the date to use is also the same date as the test. The test date will also be the date of discharge, most recent consultation etc. within the case notes.
  • If you make a mistake in the test and write a different date or use numbers not words, DO NOT PANIC, this cannot fail you. The assessors are looking for your understanding of letter writing convention in English. It is much more important that a date is on the letter than that the date you used is correct.
  1. Salutation

Use shorter for recipient’s name as full name is clearly stated above address. This can be followed by a comma.

Dear Ms. Robert,

  1. Subject

The subject is a place where information such as the name & D.O.B of the patient can be included. This can save you words in the body of the letter, but be careful not include too much information here. Use proper punctuation.

Re: Margret Milton, D.O.B. 07/09/2000
Re: Margret Milton, aged 17

Re: Margret Milton,
D.O.B. 07/09/2000

So this is a complete example of the Introduction part of the letter:

Dr M Jones
Psychiatrist
23 Sandy Road
South Seatown

27/03/2021

Dear Dr. Jones,
Re: Mrs. Katherine Walter
DOB: 26/11/1975

OET Letter correction service

Responses

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  1. Dr Grace Parker
    Consultant neurologist
    Newton hospital
    Newton
    11.07.2020
    Dear Dr Parker
    I am writing to refer to you this female medical receptionist for urgent neurological assessment for her right eye ptosis.
    She is a married woman with two children and lives with her husband. She has a family history of migraine(mother) and stroke(grandmother). Is having history of migraine for which she was treated back in January 1997 and again in february 1998.OTC ibuprofen and vicodin were used to treat those migraine attacks.
    On 15.10.2010 she was treated for her depression, however her migraine improved. Zoloft was used to. treat her depression.
    Now she is having blurred vision from 3 days with severe bifrontal headaches. One week back she had urti .
    On physical exam she was found to have ptosis .Rest of her neurological and systemic exam was normal .However she is overweight and has a BMI of 31.
    I would like you to kindly do an urgent neurological assessment of this lady .Thanking you in anticipation. If you have any queries will be more than happy to answer them.
    Dr Sami

  2. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    07/11/2020
    Re: Mrs. X, DOB : X/X/X
    Dear Dr. Parker,
    I am writing to refer Mrs. X, who has ptosis on her right eye which requires an urgent neurological assessment and further management.

    Mrs. X complaining of blurred vision for the past 3 days, especially while working on her computer associated with severe bifrontal headache with the pain scale of 5/7. Also, she has double vision and feel painful while moving her right eye. As a result, she is unable to move her right eye. Her husband reported that her right eye is bulging. On examination, the right eye is ptotic, with no protrusion nor signs of infections. Her general examinations are normal except her BMI is 31.

    Mrs. X is a married medical receptionist with 2 children. She is a social drinker and non-smoker. Her past medical histories including: migraine and depression, which she is taking Zoloft 20mg and Vicodin 50 mg.

    I would feel grateful if you could do urgent assessment and provide further management on this case.
    Please do not hesitate to contact me if you need any further assistance.

    Yours sincerely,
    Doctor

  3. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    10/04/2021
    Dear Dr. Parker,
    Re: Mrs x
    I am writing to refer Mrs X who has demonstrating signs of ptosis ,your urgent evaluation would be highly valued.
    Mrs X who is working as a medical receptionist , married and has two children. She is a social drinker and non-smoker. Her past medical histories including: migraine and depression, for which she is taking Zoloft 20mg and Vicodin 50 mg.
    On 11/07/2020, Mrs X presented complaining of decreased vision over computer office, blurred vision for 3 days and bifrontal headache. Additionally, she reported a painful movement of both eyes mainly on right eye, unable to move Rt eye and double vision Here general and neurological examinations were unremarkable.
    Your further assessment and management would be highly appreciated . Please do not hesitate to contact me if you have any queries and if possible to forward me the feedback of the diagnosis.
    yours Sincerely,
    Doctor

  4. Dr. Grace Parker,
    Consultant Neurologist,
    Newtown Hospital,
    Newtown

    11/07/2020

    Dear Dr. Parker,
    Re: Mrs. Xxxx, XX years of age

    I am writing to refer Mrs. Xxxx, XX years old medical receptionist, who is presenting with the right eye ptosis. Therefore, your further assessment and management would be highly appreciated.

    Mrs. Xxxx is married and has two children. She drinks alcohol occasionally. Her family history is notable for migraines related to her mother. She has a history of migraine, which was treated with Vicodin 50 mg and over-the-counter Iboprrofen; and the depression treated with Zoloft 20 mg.

    On today’s visit, Mrs. Xxxx complained of decreased, blurred, and double vision as well as painful eye movements. Furthermore, her right eye movements decreased due to the pain. She had bulging of the right eye and severe bifrontal headache. Kindly note that she recovered from an upper respiratory tract infection a week ago. During the examination, she had a low-grade fever and right eye ptosis.

    In view of the above, I am referring this patient for an urgent neurological assessment. Should there be any queries, kindly do not hesitate to contact me.

    Yours sincerely,
    Doctor

  5. Dr. Grace Parker
    Consultant Neurology
    Newtown Hospital
    Newtown
    11/07/2020
    Dear Dr. Parker,
    RE: Mrs. X, DOB: 01/01/1977
    Thank you for urgently seeing Mrs X, a 44-year-old married women with two children receptionist presenting today with right eye ptosis and blurred vision who may require further investigation.
    Today accompanied with her husband, she presented with visual impairment, blurred and double vision which has developed over the last three days. She is also complaining of bifrontal headache which was not similar to migraine headaches she used to have since 1997. She reports pain at both her eyes while moving them however the right one is worse. Examination revealed ptosis of right eye without any protrusion. Examination of other organ systems was unremarkable and fever or neck stiffness was not observed. Neurological exam was normal, there was no signs of eye infection.
    In terms of her medical history, she has had migraine for which she has been on painkillers and vicodin since 1997.
    I would appreciate your urgent attention to this patient as you feel appropriate. Should you have any further queries, don’t hesitate to contact me.
    Yours sincerely
    Dr. X

  6. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11 July 2020

    Dear Dr Parker,
    Re: Mrs X, DOB:

    I am writing to refer Mrs X, who has presented today with a right eye ptosis. Your urgent assessment and management would be highly appreciated.
    Today, Mrs X came with a 3-day history of blurred vision along with diplopia and painful movements in her both eyes. She reported having severe bifrontal headache for the past 5days and could not move her roght eye. Mrs X thought her symptoms might be related to URTI that she had developed a week ago.
    On examination, there was a ptosis in her right eye, however, there were no signs of eye infection. Neurological evaluation revealed fluent and clear speech and her reflexes as well as sensation and power were unremarkable.
    Mrs X has been under my care since 1997, when she was diagnosed with migraine. She was prescribed Vicodin 50mg together with ibuprofen which improved her condition. Also, she has been taking Zoloft 20mg since 2010 to manage her depression.
    Please note that Mrs X has a family history of migraine (mother) and her grandmother died of stroke.
    Based on the above, I would be grateful if you could take over the care of Mrs X and manage her condition as you think appropriate.
    If you have any queries, please contact me.
    Yours sincerely,
    Doctor

  7. Dr Grace Parker,
    Consultant Neurologist,
    Newtown Hospital, Newtown.
    Date: 4.5.2021
    Re: miss x, DOB

    Dear Dr Parker,
    I am writing to refer miss x, who has ptosis on her right for an urgent neurological assessment and management. It started with severe bitemporal headache associated blurred and decreased vision for three days. She is unable to move her both eyes due to pain and complains of double vision. Her husband noticed her right eye getting bulged. However, on examination she doesn’t have proptosis or any signs of infection except for ptosis. Rest of her systems examination were normal.
    She is known case of migraine and has taken OTC ibuprofen 50mg and zoloft 20mg. She has a family history of stroke.
    She is a married medical receptionist with witj two children. She drinks alcohol occasionally ,however she a non smoker.

    I would be really grateful if you could assess her and find a definitive diagnosis and management. Please don’t feel hesitant to contact me if you need more information.

    Thanking you
    yours sincerely
    Dr D

  8. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11th July 2020

    Re: Mrs. X, 00/00/000

    Dear Dr. Parker,

    I am writing to refer Mrs. X into your care, a married medical receptionist, who has right eye ptosis. Her condition requires urgent assessment and further management.

    On 11/07/2020, Mrs. X presented complaining of decrease and blurred vision for the past 3 days over computer office related associated with severe bifrontal headache with pain scale of 5/7. She also reported significant painful movement of both eyes including double vision. A week ago, she suffered from upper respiratory tract infection in which, series of examination were performed whereas results showed unremarkable findings and no signs of infections except her BMI.

    Mrs. X lives together with his husband and 2 children. She drinks occasionally and is a nonsmoker. She has a maternal history of migraine and her grandfather died of stroke. Her history of continuous migraine attacks were treated of Vicodin 50mg and also prescribed a Zoloft 20 mg for depression.

    It would be greatly appreciated if you could see Mrs. X for neurological assessment as you feel appropriate.

    Should there be any queries, kindly do not hesitate to contact me.

    Yours sincerely,
    Nurse in- charge

  9. Dr Grace Parker
    Consultant neurologist
    Newton hospital
    Newtown

    11/7/2020

    RE: Mrs YXZ (age)

    Dear Dr Parker,

    I would like to refer my patient, Mrs XYZ, for urgent neurologic assessment for severe bifrontal headache and painful movement of the eyes, especially on her right side.

    Mrs XYZ is a medical receptionist who has a history of multiple episodes of severe migraine headaches since 1997, associated with vomiting, photophobia and auras. these were treated with vicodin 50mg and OTC ibuprophin. She also has a family history of migraine on her mother.

    She is currently on ibuprophin- Vicodin 50mg for migraine and Zoloft 20mg for her depressed mood, instituted on 15/10/2010. She had no known allergins.

    Mrs XYZ came in today after three days of blurred vision with severe bifrontal headache, unlike her usual migraine headaches and painful movement of both eyes, especially on her right side. She also reports reduced vision when looking at the computer screen. Her husband also noticed bulging of her right eye.

    Her physical examination was normal with no fever, neck stiffness or any symptoms of high intracranial pressure, she only reports a URT infection a week ago that has subsided. Her vitals are normal, eye examination showed not protrusion or infection. The patient had clear speech and normal reflexes.

    Thank you for seeing Mrs XYZ for further evaluation at your earliest convenience and if you have any questions please feel free to contact me.

    sincerely

    Dr

  10. Dr Grace Parker
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr Parker
    Re: Mrs. X (DOB : XX/XX/XXXX)

    I am writing this letter to refer Mrs X, a xx- year old medical receptionist for urgent neurologic evaluation regarding her right eye proptosis.

    Mrs X visited today for blurred vision and severe bifrontal headache for 3 days. She was not able to move her right eye and complained painful sensation on both eyes. On examination, Mrs X was obese woman (BMI 31), her vital signs were stable and right eye proptosis was noted. Other neurologic signs and symptoms were not specific.

    She had a past history of occasional headache, migraine and depression, which were controlled with ibuprofen, zoloft and vicodin. She addressed that today’s symptom is totally different from previous migraine attacks.

    I would be grateful if you could assess her right eye proptosis at your earliest convenience and provide her the proper management. If you require any further information, please do not hesitate to contact me.

    Yours Sincerely,
    Dr x

  11. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr. Parker,
    RE: Mrs. X, D.O.B: XXX

    I am writing to refer Mrs. X, a married female receptionist who has developed ptosis of the right eye. Your urgent assessment and management would be highly appreciated.

    Mrs. X has a BMI of 31 and has a family history of migraine in her mother.

    Initially, on 10/01/1997, Mrs. X presented with the complaint of a headache of 30 minutes duration (followed by a 2-day history of an aura) along with several bouts of vomiting. Therefore, presuming migraine, she was commenced on Vicodin and ibuprofen.

    On her subsequent visits, Mrs. X’s migraine improved gradually. However, she had been feeling depressed. Subsequently, in addition to previous recommendation, Zoloft was started.
    Today, Mrs. X complains of a decreased and blurred vision, diplopia, painful movement of both eyes and a severe bifrontal headache. Also, she reports having an upper respiratory infection a week ago. Apart from ptosis of the right eye, her examination was unremarkable.

    Therefore, Mrs. X is being referred to you for further management. Should there be any queries, kindly feel free to contact me.

    Yours sincerely,
    Doctor

  12. 17 May 2021

    Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    Dear Dr. Parker,
    Re: Mrs. X, DOB -DD/ MM/ YYYY

    I am writing to refer Mrs. X, a ____ -year-old medical receptionist for urgent assessment of ptosis of her right eye.

    Mrs. X had presented today morning with complaint of diminished and blurred vision since 3 days. This was associated with painful movements of both the eyes (right > left) and bilateral diplopia. She also complaint of severe bifrontal headache. Her husband had noticed bulging of the right eye. She suffered from an upper respiratory tract infection one week ago. On examination, the right eye showed ptosis. Rest of the examination and her vitals were normal.

    Mrs. X has a history of migraine since 1997. She takes ibuprofen – vicodin 50mg for the attacks. Her attacks have improved in the last decade. Her mother also had migraine and her maternal grandfather died from stroke. She was diagnosed with depression in 2010 and started on Zoloft 20mg for the same.

    Mrs. X is married with two children. She occasionally consumes alcohol and is overweight with a BMI of 31.

    I request you to kindly assess Mrs. X for optimal management of ptosis. If you have any queries, please do not hesitate to contact me.

    Yours sincerely,
    Doctor

  13. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    05/17/2021
    Re: Mrs., X
    Dear Dr Parker,
    Greetings of the day, May i refer to you this … years old female, medical receptionist, married (lives with her husband) and has 2 children and has no special habits except drinking alcohol occasionally and no known allergies. she had recurrent attacks of migraine since 1997 and depression since 2010 and both treated by Zoloft 20mg and Vicodin 50 mg . Her mother also had migraine and her grand mother died of stroke. She presented to me today by decreased her vision over computer office, blurred vision for 3 days. She has severe bifrontal headache 5/7, not like migraine. She is unable to move her right eye, and has painful movement of both eyes more at right eye and also has double vision in both eyes. Her husband noticed bulging of her right eye. she got upper respiratory tract infection a week ago. On physical examination, her bllod pressure was 127/83, her Temprature was 37.6, her respiratory rate was 16, her Pulse was 80, her body mass index was 31.
    However, she needs an urgent neurological assessment. So, please to examine her and send to me your report for further management of her. Please do not hesitate to contact me if you need any more information.

    Thanks a lot.
    Yours,
    Dr ……

  14. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital, Newtown

    19 – 05 – 2021

    Re : Mrs XYZ, DOB : X.Y.Z

    Dear Dr Parker
    I am writing this referrral letter to you regarding the above mentioned patient for urgent neurological assessment.
    She is mother of two children and lives with husband. She works as medical receptionist and has no history of known allergy and smoking. Her family history suggests migrain in mother and death due to stroke in grandmother while fathers history is not known.
    Her past medical history is suggestive of migrain which started as headache with photophobia and phonophobia in January 1997 when vicodin 20 mg was prescribed along with OTC iburprofen. In February 1998, she prsented with migrain attacks with variety of symptoms and dose of vicodin was increased to 50 mg. In october 2010, she was found to have low mood while migrain was improved. She was diagnosed as depression and treated with zoloft 20mg while previous treatment for migrian continued.
    In July 2020, she presented with 3 days history of decreased and blurred vision, severe bifrontal headache 5/7 not charecteristic of mirgain. She reported painful eye movements more in right eye. She was unable to move her right eye which was seen as bulging by her husabnd. She had respiratory infection one week ago. Negtive hisoty noticed for fever, neck stiffness, SOB, nausea, urinarym joint pain and ear symptoms. Her assement revealed BP127/83, Temp 37.6, RR 16, Pulse 80, BMI 31. Though pstosis was seen in right eye, there was no sign of eye protusion and infection. Examination of chest and hear was normal. In neurologicla exmamination, her speech was found to be fuent and clear with no abnormaility noticed in sensation, power, reflexes.
    I would like you to perform an urgent neurological assessment for this patient.
    If you require any further information regarding this patient, I would be glad to provide the same.
    Thanking you

    Dr

  15. Dr Grace Parker,
    Consultant Neurologist,
    Newtown Hospital,
    Newtown.
    11/07/2020
    Dear Dr Grace Parker,
    Re: Mrs xxxxxxxxxxx DOB xx/xx/xxxx
    Thank you for seeing Mrs xxxxxx xx-year-old medical receptionist, who is presenting with right eye proptosis for further evaluation and management.
    Mrs xxxxxx, is complaining of a decrease, blurred vision over the last 3 days associated with severe bifrontal headache. She is unable to move her right eye and there is pain on movement of both eyes which is more in right. Further more she has double vision in both eyes. Her husband noticed bulging of the right eye. There was a history of upper respiratory tract infection one week prior to symptoms. On my examination she did not have features of meningism, no signs of eye infection. However her right eye ptosis noted , there was no proptosis. Her other vitals were normal.
    Initially in 1997, she experienced a headache with aura and photophobia which was treated as migraines with Vicodin 20mg. In 1998 she presented with migraine attack of variety of symptoms. Following titrating vicodin upto 50mg the migraine was improved. Later 2020, she was diagnosed with depression, treated with Zoloft 20mg.
    In her family, her mother had migraines, grandmother had a stroke. She occasionally takes alcohol, does not smoke and there was no significant allergic history.
    I am referring Mrs xxxxxx to you for further neurological assessment and management of her acute painful right eye ptosis. Please feel free to inquire further information with regard to Mrs xxxx.
    Thank you.
    Doctor.

  16. 27 May 2021
    Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    Dear. Dr. Parker
    Thank you for seeing Mrs. “X”, a XX year-old, medical receptionist patient who consulted for a 3 days diplopia and bilatera eye movement difficulty with associated RT eye ptosis.

    Mrs. “X” has an history of an upper respiratory tract infection a week ago. Three days before consulting she started with blurred and decreased vision, pain when moving both eyes, and unablebility to move RT eye, and diplopia.

    On physical examination Mrs “X” presentes RT eye ptosis with no eye protusion. The rest of the examination was unremarkable.

    Mrs. “X” has personal history of migrains diagnosed between 1997 and 1998, treated with ibuprophen and vicodin (50 mg). On her family history, her mother was also diagnosed with migrain, and her grandmother died caused by a stroke.

    Mrs. “X” is a non smoker patient who occasionaly consumes alcohol. There are none known allergies.

    I would be greatful that you coul take an urgent neurological assesment on her.

    Yours sincerly,

    Dr. López

  17. Dr Grace Parker,
    Consultant Neurologist,
    Newtown Hospital,
    Newtown.

    11/07/2020

    Re: Patient Mrs A
    DOB xx/xx/xx

    Thank you for seeing Mrs A, a XX year-old lady who works as a Medical receptionist. I am referring this patient for an urgent neurological assessment for suspected brain tumour.

    Mrs A first presented to us on 10/01/1997 for suspected Migraine. At that time, she was complaining of headache associated with vomiting, photophobia and phonophobia. We have prescribed her Tab Vicodin 20mg and continued her regular Tab Ibuprofen PRN. She had intermittent migraine attacks with variety of other symptoms but relieved with medications that was advised to her. On further assessment on 15/10/2010, the migraine had improved but she started complaining of low mood. We have added Tab Zoloft 20mg for depression and continued her regular medications for migraine.

    Mrs A is a married woman with 2 children. She lives with her husband. She drinks alcohol occasionally and denied smoking. She has family history of migraine from her mother and stroke from her grandmother.

    She recently came back to us on 11/07/2020 complaining of bifrontal headaches for 5/7. The symptom is worsened by blurring of vision for 3/7 associated with Rt opthalmoplegia and double vision. Otherwise, she denied any fever, neck stiffness, nausea and vomiting. On examination, we have noticed sha is having Rt eye ptosis but no protrusion. She has a BMI of 31 which is obese but her vital signs remain stable. Her nuerological also has been unremarkable.

    We would be grateful if you can see her for urgent neurological assessment and expectant management.
    Thank you in advance.

    Sincerely,
    Dr F

  18. 3/june/2021
    Dr grace parker
    consultant neurologist
    newton hospita;l
    newton’
    dear doctor parker

    I am rferring to you a female medical receeptionisy with complaints of decreased vision and headache for an urgent asessment

  19. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11 July 2020

    Dear Dr. Parker,

    Re: Mrs. X, DOB 10/07/1970

    Thank you for seeing Mrs. X, a 50-year-old receptionist who requires urgent neurological assessment.

    Mrs. X came today and complained of blurred vision which has been present over the past 3 days. She also had a bifrontal headache (5/7). Her right eye has been predominantly affected as she is unable to move it. Both eyes are painful although it is more painful in her right eye, and she stated that she has diplopia. On examination, her right eye had ptosis, but no protrusion was observed.

    Mrs. X has a history of migraines which she initially presented on 10/01/1997. She also had an aura that lasted for 2 days before the onset of the migraine. Vicodin 20mg was prescribed. One year later, she had another bout with a variety of symptoms. Therefore, a stronger dose of Vicodin was prescribed. On 15/10/2010, her migraine had improved with no more attacks. However, she had been diagnosed with depression. In addition to her ongoing medication, she was prescribed Zoloft 20mg. Please note, she has a family history of migraines and stroke.

    I would be grateful if you could examine Mrs. X at your earliest convenience and conduct an immediate evaluation to diagnose the condition.

    If you have any queries, please do not hesitate to contact me.

    Yours sincerely,

    Doctor

  20. Dr. Grace Parker
    Consultant urologist
    Newtown Hospital
    Newtown
    June 14, 2021
    Dear doctor Parker,
    Re: Mrs. X xx years old
    I am writing this letter to kindly and urgently refer Mrs. X who has right eye ptosis and blurred vision which may require urgent neurological assessment.
    Mrs. X is complaining of decreased and blurred vision of 3 days duration associated with severe headache, painful eyes movement, double vision in both eyes and inability to move her right eye which is bulging as noticed by her husband. However; she denies any fever, neck stiffness, nausea or vomiting and she has no urinary, joint or ear symptoms.
    Mrs. X is a receptionist social drinker nonsmoker woman who has no allergies. She lives with her husband and has 2 children. She has a history of headache associated with vomiting and aura on 10/01/1997. She was suspected to have migraine and was treated with Vicodin 20 mg and over the counter Ibuprofen until about one year later when her migraine had improved. Moreover; on 15/10/2010 she was diagnosed with depression and was treated with Zoloft 20 mg. She has positive family history for her mother who has migraine and her grandmother who died of stroke.
    On examination; Mrs. X has normal vitals and a BMI of 31. She has right eye ptosis but no protrusion nor eye infection. Her chest, heart and neurological examination is unremarkable.
    Based on the above findings, your urgent assessment and further management of Mrs. X would be highly appreciated.
    Please do not hesitate to contact me if you need any further information.
    Yours sincerely,
    Doctor.

  21. Dr Parker
    Consultant neurologist
    Newton hospital
    Newtown

    Dear Dr Parker
    Iam writing this letter to inform you regarding a female patient who works as a medical recptionist and has recently experienced some un usual neurological symptoms.

    She was in her usual state of health and was working on her computer office when she started having decreased vision and blurring 3 days ago. This was followed by a severe bi frontal headache rated 5/7 in severity and was unlike the past migraine attacks that she had had previously. Her first migraine attack was in the year 1997 and was treated with vicodin 25 which was later increased to 50 mg on a repeat episode one year later.
    Furthermore not only was the patient unable to move her right eye and any attempts made were very painful, but also her husband noticed it was bulging. It is also noteworthy to mention that she had an upper respiratory tract infection a week ago. Even though she doesnt smoke , she drinks occasionally and has a past history of depression managed medically.

    When examined, the patient was vitally stable and Bmi 31. There was however, only right eye ptosis noted while the rest of the findings were unremarkable.

    In light of the above mentioned scenario described i would like for you to further assess the patient and investigate with radiological imaging if needed and advise treatment as required.

    Sincerely
    Dr B.A.Kon

  22. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr Parker,

    I am writing to refer my patient who needs your urgent neurological assessment.

    This patient presented to my clinic today complaining about blurred vision for 3 days with tenderness in both eyes but was more noted in right (RT) eye. She was not able to move her RT eye and her husband noted that RT eye was bulging out. She also complained about bifrontal headaches since 5-7 days. According to my assessment, vitals were normal but Rt eye showed ptosis without protusion. Rest of the neurological exam including speech was normal and possiblity of eye infection was ruled out. Due to no possible neurologic cause being identified, a plan to urgently consult a specialist neurologist for further assessment was disussed with her.

    She is currently on ibuprofen-vicodin to manage her migraine headache and reported no recent acute attacks. Similar headaches were reported in her mother and her grandmother died due to stroke. Her depression is fairly managed with zoloft.

    Your expert evaluation will be highly appreciated. Please do all necessary tests and assessments as needed urgently.

    For any further questions, please do not hesitate to contact me.

    Yours sincerely,
    Doctor

  23. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    11/07/2020
    Dear Doctor Grace,
    I an writing to urgently refer Ms….. , a … year-old medical receptionist, for bilateral decreased vision with right eye ptosis and severe unusual headache. She requires further neurological assessment.
    Ms … has 20 years history of migraine for which she takes Ibuprofen and vicodin 50 mg, and a depression that was treated with Zoloft 20 mg.
    Today, she presented with bifrontal unusual headache, scaled 5/7 and a 3 days history of blurred vision. She has been unable to move her right eye, reporting bilateral painful eye movement that is accentuated on the right eye. She admited having an upper respiratory tract infection last week.
    On examination, she has right eye ptosis without protrusion. No signs of infection were found. She has a blood pressure of 127/80, a pulse of 80 and a respiratory rate of 16. She is afebrile. The rest of the neurological examination as well as the cardiovascular examination are normal.
    Ms… needs to be urgently seen by you for further neurological evaluation.

    Please contact me if you have any queries
    Sincerely Yours
    Doctor Mariem

  24. DR. GRACE PARKER
    CONSULTANT NEUROLOGIST
    NEWTOWN HOSPITAL
    NEWTOWN

    25/06/2021

    RE: FEMALE PATIENT, URGENT NEUROLOGICAL ASSESSMENT

    DEAR DR. PARKER

    I AM WRITING TO REQUEST URGENT NEUROLOGICAL ASSESSMENT FOR A FEMALE PATIENT, WHO WORKS AS A MEDICAL RECEPTIONIST, PRESENTED TO THE CLINIC TODAY WITH 3 DAY HISTORY OF BLURRED VISION, SEVERE BIFRONTAL HEADACHES AND RIGHT EYE PTOSIS. SHE HAD ALSO REPORTED A HISTORY OF UPPER RESPIRATORY TRACT INFECTION A WEEK AGO.

    HER PAST MEDICAL HISTORY IS SUGGESTIVE OF MIGRAINE HEADACHES SINCE 1997 AND WAS PRESCRIBED IBUPROFEN-VICODIN 50MG FOR THE SAME. IN 2010 SHE WAS ALSO DIAGNOSED WITH DEPRESSION AND ZOLOFT 20MG WAS ADDED TO HER USUAL MIGRAINE TREATMENT. SHE HAS POSITIVE FAMILY HISTORY OF NEUROLOGICAL DISORDERS IN HER MOTHER AND HER GRANDMOTHER. SHE IS A NON-SMOKER AND OCASSIONALLY CONSUMES ALCOHOL AND HAS NO ALLERGIES.

    KINDLY ASSESS THE PATIENT AND PROVIDE THE BEST CARE UNDER YOUR CLINICAL EXPERTISE. PLEASE FEEL FREE TO CONTACT ME FOR FURTHER DETAILS.

    YOURS SINCERELY
    DOCTOR

  25. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr Parker

    Re: Mrs Karen Smith, DOB 10/06/1975

    I am writing to refer to you Mrs Smith, a 45-year-old medical receptionist who is suffering from right eye ptosis and will require your urgent neurological assessment and further management.

    Mrs Smith presented to me today with complaints of having blurred and decreased vision with concomitant severe bifrontal headache for the past 3 days. Her vision was doubled and painful whilst moving, mainly in her right eye which was notably bulging. She also reported to have suffered from an upper respiratory tract infection a week ago. Up on examinations, I noted right eye ptosis with neither protrusion nor signs of infection. Her other vital signs were normal except for the BMI which is 31.

    In terms of her past medical history, she’s known to have suffered from multiple migraine attacks in the past which was successfully managed by Vicodin 20 mg and OTC ibuprofen. In 2010 Mrs Smith had suffered from depression for which she took Zoloft 20mg. It should be noted that she has a family history of migraine.

    Please do not hesitate to contact me if you have any further questions.

    Yours sincerely,

    Doctor

  26. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    6/25/2021

    Re: Ms Sandra Carrol, DOB 01/12/1990

    Thank you for seeing Ms Sandra, a 30-year-old medical receptionist, who has a long history of migraines and today is presenting neurologic symptoms. I am referring Ms Sandra for neurologic evaluation and further analysis.

    Ms Sandra has a Diagnosis of migraine since 1998 and has been treated with Vicodin 20 mg for the last 22 years. Ms Sandra present today claiming symptoms of bifrontal headache that include, decreased and blurred vision, unable to move RT eye, painful movement of both eyes, double vision. Ms. Sandra’s husband noticed bulging of right eye and the patient refer upper respiratory track infection week ago. the physical examination reveal, normal vital signs, RT eye ptosis and no protrusion, no signs of infection and the rest of the physical examination is unremarkable. Therefore, I am considering red flag symptoms for which she needs further investigation.

    Ms Sandra has 2 children, is married, is a non-smoker, and the rest of History is unremarkable except for his mother who also has a diagnosis of migraines.

    Thus, would be really appreciated if you could provide a complete assessment for Ms. Sandra’s condition at your earliest convenience. Please do not hesitate to contact me if require more information.

    Yours Sincerely,

    Doctor

  27. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    2021/06/05
    Dear Dr Parker,
    Thank you for seeing this medical receptionist who has right eye ptosis for urgent neurological evaluation.
    She visited me on 7th september 2020 with decreased and blurred vision of bilateral eyes for three days associated with pain while moving eyes especially more on right side. She had respiratory infection two weeks back. However, she had no other symptoms as such. On examinations, she has ptosis and high BMI(31).
    She had migraine attack twice and depression for which she has been taking ibuprofen 50mg and Zoloft 20mg respectively.
    Her mother had migraine too and her grandmother died of stroke. She drinks occasionally and does not smoke and has no allergies so far.
    I would humbly request you to examine her and do necessary investigations.
    Should you have any query, please feel free to call me.

    Sincerely,
    Doctor

  28. To
    Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr Parker,
    Re: Medical receptiontist with history of severe headache

    I hope you are doing well.I am writng to you to refer a patient for urgent neurological assessment.She is a medical receptionist who currently lives with her husband.

    There is a history of migraines in her mother whereas her grandmother died from a stroke. She is an occasional alcohol user and a non-smoker.

    In the past, she has received treatment for migraine with aura. She has responded to OTC Ibuprofen and Vicodin 50 mg.She has had depression which improved with Zoloft 20 mg.

    She noticed a new headache 3 days back. This is severe, bifrontal and different in character from her migraine.She also reports blurring of vision and reduced acuity in both her eyes in the past 3 days.
    Her examination revealed difficulty in moving both eyes due to pain.She has developed a swelling of the right eye as well, and cannot move it. There is a ptosis of the right eyelid as well.He vitals are unremarkable.She had been diagnosed with a urinary tract infection a week back.

    I would appreciate if you could see her ASAP.
    Please let me know if you require any other information.

    Yours sincerely,
    Doctor

  29. Dear Dr. Parker,
    Re:
    I would like to refer Mrs.X, who recently developed a decreased blurred vision, a painful limited movement of the right eye as well as a painful movement of the left eye, after an attack of an upper respiratory tract infection one week previously, in to your kind care.
    Mrs. X has been suffering from a severe bifrontal headache for 5 days, in addition to a blurring vision which has developed 3 days ago in both eyes. However, there were no signs of eye infection as well as a non significant neurological examination. The right eye showed some ptosis.

    It is worth mentioning that Mrs. X has been treated for migraine since 10/ 1/1997, for which she has a family history on her mother’s side. She takes ibuprofen & vicodine for the migraine.She had a depressed mood on 15/10/2010, for which she took Zoloft.

    Please accept Mrs. X for urgent neurological assessment and management.
    Your’s sincerely,
    Doctor

  30. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    dear Dr. Parker,
    RE: The Patient BOD:
    Thank you for seeing the patient, medical receptionist, married and mother of two children, who presented with headache and diplopia for assessment and further management of her condition.

    The patient presented to my clinic today with severe headache, located in the bifrontal area with 5/7 intensity. In addition, she reported bilateral diplopia, inability to move her right eye and pain when she move her eyes. also, she referred blurred vision 3 days ago and she had an upper respiratory tract infection week ago. Patient denied fever, neck stiffness, SOB, nausea, vomiting, joint pain and ear symptoms.
    She has a history of migraine and depression well controlled with Ibuprofen-Vicodin 50 mg and Zoloft 20 mg. Patient has a family history of migraine by her mother and her grandmother died due to stroke.
    On physical exam was found right eye ptosis and the rest of neurological and systemic exam was normal. However she has a BMI of 31 (overweight).
    In view of the above signs and symptoms, I believe she needs urgent neurological evaluation and further investigations and management of her condition.

    I would appreciate if you could please, assist this patient with health problem.
    If you require any information, please do not hesitate to contact me.

    Yours sincerely
    Dr. Cepero

  31. Dr. Grace Parker
    Consultant neurologist
    Newtown Hospital
    Newtown

    23/7/2021

    Dear Dr. Parker,
    Re: Pt x , DOB xxx

    I am writing to refer Mrs x, a X year old patient who presented with right eye ptosis, for urgent neurological evaluation.

    Mrs. X presented with decreased vision which started 3 days ago. She also has a severe bifrontal headache with a pain score of 5/7. She is unable to move her right eye due to pain. Apart from right eye ptosis, her physical examination is unremarkable. Her BMI is 32.

    She has a history of migraines that began in early 1997 for which she has been taking Ibuprofen-Vicoden 50mg. She also has a history of depression for which she takes Zoloft 20mg.

    She is a medical receptionist and does not smoke or have any allergies. She drinks alcohol occasionally. She has a family history of migraines (mother) and stroke (grandmother).

    I would be grateful if you could urgently assess her situation and please do not hesitate to contact me if you have any queries.

    Yours sincerely,
    Doctor Fatima

  32. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr.Parker,
    I am writing to refer this female receptionist, with headache and eye problems, for urgent assessment at your practice.

    She initially attended our clinic on 10/01/1997 complaining of headache associated with vomiting and 2-day history of aura preceded by photophobia. Therefore, migraine was suspected and Vicodin 20 mg was prescribed in addition to ibuprofen that she was already taking.

    Unfortunately, despite her treatment, she came back a year later with worsening symptoms and Vicodin was increased to 50 mg.

    On 15/10/2010, her migraine improved. However, she reported low mood and Zoloft was added for a suspected diagnosis of depression.

    Today, she has been experiencing blurred vision for the past 3 days associated with severe bifrontal headache , double vision in both eyes, as well as painful eye movement that is more pronounced in the right eye. She had an upper respiratory tract infection a week ago and her husband has noticed right eye bulging. No other symptoms were reported. Her examination revealed right eye ptosis and her BMI was 31. All other findings were unremarkable.

    Based on the above, your urgent neurological assessment and appropriate management of this patient would be appreciated.
    If you have any further questions please do not hesitate to contact me.

    Yours sincerely,
    Doctor

  33. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    Date: 11/07/2020

    Thank you for seeing this patient who is presenting with urgent neurological signs and symptoms. It would be greatly appreciated to manage her condition as you think appropriate.

    The patient does not smoke but she drinks occasionally. Regarding her medical history, she presented twice with symptoms of migraine for which she was managed accordingly.

    On 15/10/2010, she came to us reporting symptoms of depression and she was given treatment for this.

    Today, she has severe headache and blurred vision. In addition, she reports double vision in both eyes and a feeling of pain while moving both eyes but more in the right eye. Examination was unremarkable apart from right eye ptosis.

    In view of the above, i would like to refer this patient for further management. Please feel free to contact me if you have any queries.

    Yours sincerely,
    Doctor Abdullah

  34. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/ 2020

    Dear Dr Parker,
    RE; Patient X

    Im writing to refer to you Mrs X who has presented with acute neurological symptoms about 3 days ago mainly in the form of right eye ptosis, pain and opthalmoplegia for your urgent care and assessment

    Mrs X is a married women with two children, she works as a medical receptionist, she is a non smoker with no allergies and a maternal history of migraines. She has a BMI of 31.

    She is currently complaining of decreased and blurred vision for 3 days along with severe bifrontal headache (5/7) not similar to her previous migraines. She has opthalmoplegia of the right eye and painful eye movements bilaterally. she also had a history of upper respiratory track infection a week ago.

    On examination all vital signs are normal, and right eye ptosis is noted with no signs of eye infection and unremarkable neurological exam.

    She has a past history of migranes that began about 20 years and is managed with 50 mg vicodin and ibuprofen. In 2010 20 mg zoloft was added for managment of depression.

    I would be grateful if you can do an urgent neurological assessment so that we can determine how to proceed with the managment accordingly.
    Thank you very much,
    Dr, Y

  35. Dr Grace Parker
    Neurologist
    Newtown hospital
    Newtown
    03.08.2021
    Dear Dr Parker,
    Re: Ms XXX D O B : ???

    I am writing to urgently refer a married medical receptionist patient who complaining of severe headache associated with ptosis of the Rt eye. Your further assessment would be highly appreciated.

    Regarding PMH, the patient was diagnosed with migraine on 1997 and put on Vicodine 20 mg, about one year later the dose of Vicodine was augmented to 50 mg with addition of Ibuprofen, the patient showed good improvement on this regimen until about 3 years later when he developed depression for which he received Zoloft 20 mg. Her family history is significant for her mother history of migraine and her grandmother died of stroke. The patient is not smoker though she drinks occasionally. No history of allergy.

    Today the patient presented with complain of severe headache ( 5/7 on severity scale) associated with decrease vision over last 3 days bilateral diplopia and painful eye movement especially on Rt side. On examination apart from ptosis on Rt eye, here general and neurological examination was completely normal.

    In view of the above, I am referring this patient for further assessment of her condition. For any queries please contact me.

    Yous sincerely,
    Doctor

  36. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    11/07/2020
    Dear Dr. Parker,
    Re: Mrs. Rebecca Smith, 35/F
    I wish to refer this patient presenting with severe bifrontal headaches and associated visual disturbances for your urgent evaluation and management.
    Mrs. Smith accompanied her husband with the above symptoms which began 3 days ago. The problems began as visual blurring which started during her work as Medical Receptionist requiring long exposure to Computer screen. This was followed by severe headaches, unlike any she has had before, photopsia and painful eye movements (R>L). She admits to have recovered from an upper respiratory infection a week back. Her husband adds to have noticed her eyes to be bulged out. Examination of the patient was essentially normal apart from right eye ptosis and BMI 31.
    In her past she has suffered from typical migraine, diagnosed first in 1997 and treated adequately on ibuprofen and vicodin 50 mg. Now the attacks are said to be rare. Additionally, she suffered from depression in 2010 and was managed on Zoloft 20 mg.

    In view of the above, I consider it appropriate that she be assessed and managed further under your expert care.
    Please feel free to contact me for any further information.

    Regards.
    Yours sincerely,
    G.P

  37. 08/08/21
    Dr Grace Parker
    Consultant neurologist
    Newton Hospital
    Newton
    Dear Dr Parker
    Re: Medical receptionist

    I am writing to refer a medical receptionist to you, who suffers from a headache, for further evaluation and assessment.

    In the first visit, She presented a history of a headache with aura and vomiting. A migraine was suspected, so she has treated with Vicodin 20 mg. In addition, she also has a mother who suffers from migraines and a father who died of a stroke.

    One year later, She presented a migraine attack with a variety of symptoms. It was managed with Ibuprofen plus Vicodin.

    On her third visit, she mentioned that migraine has improved and has not had more attacks. It seems to show a low mood. For this instance, Zoloft 20 mg was added to her current treatment.

    Today, She complains of a decreased vision for the last three days and painful movement of both eyes. Also, her husband noticed a bulging in her right eye. She also describes frontal migraines, which do not compare to her usual migraine. Moreover, she presented an upper respiratory infection a week ago. On examination, She showed no alteration in her vital signs, BMI 31, RT ptosis and the rest of the exam with no abnormalities.

    Kindly provide appropriate evaluation and management of my patient.

    If you have any queries, please feel free to contact me.

    Sincerely yours,

    Dr Diego Ovando

  38. Dr Grace Parker
    Neurologist
    Newton Hospital, Newton

    Dear Dr Parker
    11/07/2020
    I am writing for referral of female with ptosis, right eye pain with movement, blurry vision and new onset cefalea different form those in the past.

    Patient has a history of migraines and depression, that are well controlled with treatment ibuprofen 50mg for migraines, and Zoloft 20 mg daily for depression. On 11/07/2020 she returns for consult due to decrease of vision, and blurriness, she also complains of new onset bifrontal cefalea with pain 5/7 on scale unlike migraines she has experienced in the past. on physical examen ptosis of right eye is noticed as well as pain of right eye with movement, there are no signs of infection of the eyes, and vital signs are normal.optic neuritis is suspected.

    Patient is married, mother of 2. She has no other history of chronic medical conditions and a family history of migraine in mother and stroke in grandmother, she denies any allergies.

    I would appreciate for your collaboration for continued assessment, diagnosis and management of her condition. if you should have any questions feel free to contact me at any time

    Dr Marrero

  39. Dr Grace Parker
    Consultant Neurologist
    Newton Hospital
    Newton

    11/07/2020

    Dear Dr Parker
    Re:
    Thank you for seeing our patient who will need your urgent neurologic assessment.
    She presented today complaining of blurred vision that started about three days ago while she was at the computer office. She has also had severe bifrontal headaches which she rates at 5/7 and says her headache is not similar to her migraine headache. She reports pain with movement of both eyes which is worse on the right and has experienced double vision. Her husband has also noticed bulging of her eyes. She however denies fever, neck stiffness, SOB, nausea, vomiting, urinary, joint pain or ear symptoms.
    Her vitals are within normal limits, and she has a BMI of 31. There is right eye ptosis with no eye protrusion. Her chest, heart, and neurologic examinations are not significant and she does not show any signs of infection.
    She has a history of migraines with aura for which she takes Ibuprofen-Vicodin 50mg and depression for which she takes Zoloft 20mg. Her family history is significant for migraines in her mother and her grandmother died of a stroke. She works as a medical receptionist and drinks alcohol occasionally. She does not smoke and has no known allergies.
    I will be most grateful if you can see my patient at your earliest convenience for an urgent neurologic assessment.

    Sincerely,
    Doctor.

  40. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    11.07.2020

    Dear Dr Parker

    I am writing to refer this female patient who presented with sudden blurred and decreased vision in both eyes of three days duration for urgent neurological assessment .

    Patient presented today complaining of decreased vision accompanied by severe bifrontal headache which was unusual to her as she had a frequent attacks of migraine before. She was unable to move her right eye because of pain upon movement of both eyes , more on the right. Patient recalled having an upper respiratory tract infection a week before her symptoms . she was found to have right eye ptosis on examination, but the rest of her exam was within normal.
    Patient is a medical receptionist ,married mother of two,who was diagnosed with migraine with aura in 1997 for which she takes vicodin 50mg, Ibuprofen . she also suffers from depression and on Zoloft 20mg , with a family history of strokes.

    Upon review of the above , patient is in need of your urgent evaluation and assessment to reach a diagnosis and management .

    your sincerely
    GP

  41. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    11/07/2020
    Dear Dr Parker
    Re: Ms X, Medical receptionist
    I am writing in regards to refer this female medical receptionist for further urgent neurological assessment and treatment.
    Ms X presented with the complaints of blurring of vision from last 3 days with bifrontal headache. There were restricted and painful movement of right eye with slight bulging. On examination, Right eye shows ptosis. There are no signs of eye protrusion and infection. Examination of all other systems is normal.
    She had a past history of headache followed by photophobia which on assessment was diagnosed with migraine and was put on Vicodin 20mg. 1 year later migraine attack was occurred again and dose of Vicodin increase to 50 mg. In 2010 she was diagnosed with depression for which she was prescribed with Zoloft 20 mg along with ibuprofen and Vicodin 50mg.
    Her mother had a history of migraine and grandmother died of stroke. She is a occasional drinker with no smoking habits.
    I would appreciate your urgent assessment for this patient.
    Yours Sincerely
    Doctor

  42. To:
    Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital

    19 August 2021

    RE: REFERRAL FOR URGENT NEUROLOGICAL ASSESSMENT
    Thank you for seeing Mrs. X who has underlying migraine on Vicodin 50mg and Zoloft 20mg for depression.

    She presented with decreased vision and blurred vision for 3 days associated with severe bifrontal headache for 5 days. She complained of painful right eye movement and has double vision in both eyes. Also there was bulging of right eye. It was preceded by URTI a week ago. Otherwise, there was no fever, neck stiffness, SOB, nausea, vomiting, urinary, joint pain and ear symptoms.

    On examination, she is obese with the BMI of 31. Her vital signs are stable. There is right eye ptosis but no eye protrusion and no signs of eye infection. Other systemic examination including neurological assessments are unremarkable.

    Mrs. X is a medical receptionist who is a mother of two children. She is an occasional alcoholic and a non-smoker. She has no known allergies. Her family history includes mother who has migraine and grandmother who passed away due to stroke.

    In this case, my impression is right eye ptosis for investigation and to rule out brain lesion.

    I am referring this case to you for urgent neurological assessment. Kindly assist the patient and provide your expertized management. Should there be any queries, please do not hesitate to contact me. Thank you.

    Yours sincerely,

    Dr. Christine Low
    Medical officer
    Clinic Mediviron

  43. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11-Jul-2020

    Dear Dr. Parker,

    Re: Female Patient

    Thank you for seeing the Medical Receptionist. I am writing this referral for urgent evaluation of
    of visual symptoms.

    She has a PMH of migraine since 1997 treated with ibuprofen and vicodin 50mg. She has BMI of 31.
    She came to the clinic today due to symptoms of blurred vision over the past 3 days after an upper respiratory tract infection 1 week ago. It is associated with bilateral double vision, painful eye movement bilaterally that is more severe in the right eye and inability to move the right eye. She also complains of severe bifrontal headache 5/7 in intensity that does not feel like migraine. She denies any fever, neck stiffness, shortness of breath, nausea, vomiting, joint pain, urinary and ear symptoms.

    Examination showed BP of 127/73, Temp of 37.6, right eye ptosis without protrusion, no eye infection, clear lungs, fluent speech , normal sensation, power and reflexes.

    She is married with 2 children. She drinks alcohol occasionally and does not smoke. She has no known allergies.

    Please evaluate her and perform a neurological assessment. Please feel free to reach out to me for any questions.

    Yours Sincerely,

    Doctor

  44. Letter of referral

    Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11 July 2020

    Dear Dr. Parker,

    Re: Mrs. XXX
    DOB: XYZ

    Thank you for seeing Mrs XXX, who has been in my care since 1997 for treatment of repeated attacks migraine and requires your urgent assessment for her recent onset visual symptoms and headache.
    Mrs. XXX presented today with decreased, blurred and double vision, painful eye movements (right more than the left) and swelling of right eye. This was accompanied by a severe bifrontal headache rated 5/7 by the patient. She suffered from a viral URTI one week ago, however, there was no history of fever, SOB, nausea, vomiting, urinary complaints, joint pain or ear symptoms. Examination revealed right eye ptosis, with no signs of eye infection. Neurological examination was intact, vitals stable and her BMI was 31.
    Mrs. XXX has been previously treated for repeated attacks of migraine with aura since 1997 with ibuprofen and vicodin 50mg. She has reported no further attacks since 15.10.2010 but has continued with the medications. She was diagnosed with depression 10 years ago and started on Zoloft 20 mg OD. Her family history is significant for migraine in mother.
    A medical receptionist by profession, Mrs. XXX drinks occasionally, does not smoke and has no known allergies.
    I would be grateful if you could assess and advise regarding the further management of her recent headache and worsening visual symptoms.
    If you require any further information, please feel free to contact me.

    Sincerely,

    Doctor

  45. Dr Grace Parker
    Neurologist
    Newtowen Hospital
    Newtowen
    11/7/2020
    Dear Dr Parker
    Thank you for seeing Mrs x who is referred for your expert assessment of her neurological symptoms.
    Mr x is a medical reciptionist living with her husband and has 2 offsprings. She drinks alcohol occasionally and she is non smoker.
    Mrs x’s medical history is relevant of migraine for which she has been prescribed Zoloft and Vicodin. Her family history is positive for cerebral stroke for her grandmother and migraine for her mother .
    On 11/07/2020 Mrs x presented in the office after one week of Respiratory tract infection complaining of Diplopoda, Rt eye pain, blurring of vision , and headache.
    Neurological examination revealed Rt eye lid ptosis associated with no ophthamoplegia, no exophthalmos, no speech or other neurological deficits.
    Your thorough neurological assessment and further management would be highly appreciated. Please feel free to contact for any queries.
    Regards,
    Dr .Belal

  46. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11July 2020
    Dear Dr Parker

    I am writing this letter to urgently refer patient X a Medical receptionist married with 2 children who came to our clinic with complaints of blurring of vision over the last 3 days along with pain and double vision on both eyes. Your specialist neurological assessment and evaluation would be highly appreciated.

    Mrs X first presented with headache of 30 minutes duration with vomiting 4-5 times a day over a year ago. She also experienced a 2 days history of aura followed by photophobia and phonophobia. Medications prescribed was over the counter ibuprofen. Her migraine was recurrent with varying symptoms suggestive of depression and migraines headcahes.

    Mrs X presented today with complaints of decreased vision whilst using the computer. She also reported having blurry vision for 3 days with severe bi-frontal headaches. Mrs X has pain on both eyes movement but more on the RT eye with double vision. Vital signs, physical and neurological examinations were normal except for her RT eye ptosis.

    I would be grateful if you could assess Mrs X at your earliest convenience time for further evaluation as I am concern the possibility of ptosis.

    If you need any further question please do not hesitate to contact me.

    Sincerely yours, Docotr

  47. Dr. Grace Parker,
    Consultant neurologist,
    Newton Hospital
    Newton

    11th July 2020

    Dear Dr. Parker,
    RE: Mrs. XYZ
    DOB: xx/xx/zzzz

    I am writing this letter on behalf of Mrs. XYZ to request an urgent neurological assessment for her. She presented to me today with complaints of blurred vision for last 3 days and severe bifrontal headache for the last 5 days. She has been having a double vision of both eyes and painful eye movements more pronounced on the right. She denied any fever, vomiting, or neck stiffness. Even though her husband noticed a bulging of the right eyeball, my clinical examination showed that it was ptosis of the right eyelid rather than the protrusion. The rest of the neurological examination and other systems were within normal limits. There were no signs of eye infection.
    In 1997, Mrs. XYZ was diagnosed as a case of migraine with aura as she presented with classical symptoms, and was treated with Vocidin 20 mg along with ibuprofen. Her symptoms persisted and hence the dose of vicodin was increased to 50 mg. This brought resolution of symptoms and she was stable till 2010 when there were episodes of low mood. She was given a diagnosis of depression and treated with Zoloft 20 mg along with previous medications. Mrs. XYZ is working as a receptionist and lives with her husband and 2 children. She is an occasional alcoholic and non-smoker and there is no significant family history.
    I am hereby requesting an urgent neurological assessment for Mrs. XYZ as I am worried that a delay in care might cause worsening of her condition and result in a permanent vision loss. Please don’t hesitate to contact me, in case you have any further queries regarding Mrs. XYZ’s medical history

    Yours Sincerely
    Dr. ABC BCA

  48. Dr. Grace Parker
    Consultant Neurologist
    Newton Hospital
    Newton

    11/07/2020

    Dear Dr. Parker,

    Thank you for seeing my patient, a medical receptionist, for her severe acute onset headache with associated eye symptoms. I am referring her for an urgent neurological evaluation and diagnosis.

    She presented today after a 3 day history of severe bilateral headache (reported 5/7) associated with double vision and painful movement of her eye. The pain is more pronounced in the right eye. On examination, vitals were normal and her neurological assessment was clear. However, right-sided ptosis was observed.

    The patient has a history of migraine attack for which she was prescribed Ibuprofen and Vicodin in 1998. She reported an improvement of her episodes in 2010, however complained of low mood. Then, she was diagnosed with depression and prescribed Zoloft along with continuation of her migraine medications.

    She is a non-smoker and only drinks occasionally. Her BMI is 31 and has no known allergies. She has a family history migraine in her mother and her grandmother died of a stroke.

    It is requested that you may perform a neurological evaluation of her symptoms at your earliest convenience.

    Please contact me for any queries.

    Yours Sincerely

    Dr. Muhammad Sohaib Alvi

  49. 07/09/2021

    Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    Dear Dr Parker
    RE: Female medical reciptionist

    I am writing to urgently refer a married female that showed a sudden onset of neurological symptoms. it would appreciated if you could assess and examine her as soon as possible.

    On today’s consultation, she complaint of decrease and blurred of vision for the past three days, sever bifrontal headache, in addition to painful movement of both eyes but more in the right which also associated with double vision. Her husband notice bulging of the right eye. she had history of respiratory infection a week ago. no other complaint mentioned. On examination,all her vitals were normal, no bulging of the eye, but ptosis in the right eye and her neurological assessment showed no abnormalities.

    On 10/01/1997, the symptoms started with headache, vomiting and aura preceded by photophobia. she did not seek medical advice, instead she got over the counter ibuorifen. migraine was suspected fo which vicodine commenced. After more than a year, symptoms presented again and ibuprofen were added with increase of vicodine dose. After 11 years, her migraine symptoms were cntrolled but she showed aigns of deppresion, zolfot was prescribed.

    Regarding her social history, she a married medical receptienist with two children. lives with her husband. she drinks but never smokes. In concern of her family history, her mother had migraine and her grandmother died of stroke.

    In light of the above, it would be greatly appreciated if you could take over her condition urgently, for assessment and managment the way you see it.

    if you have any questions, please feel free to contact me.
    Yours sincerely,
    Doctor

  50. 10/09/2021

    Dr Grace Parker
    The Consultant Nuerologist
    Newtown Hospital
    Newtown

    Dear Dr Parker,

    Re: Mrs Anna Jones DOB 28.11.1990

    I am referring Mrs Anna Jones to you for urgent neurological assessment. She is a medical receptionist with recent worsening headache and associated severe ocular features.

    Mrs Jones initially had history of migraine of 20 years duration which had been controlled on zoloft and ibuprofen with some improvement before latest increase in severity of symptoms observed during last visit.

    She initially presented to the practice on 10/01/1997 with headache, vomiting with aura preceded by photophobia and phonophobia. On account of these symptoms, vicodin 20 mg was prescribed based on presumptive diagnosis of migraine.

    On subsequent visits (after 1 and 3 years of initial visit), Mrs Jones’ initial symptom was noticed to have improved on the current medication. However, she had features consistent with depression which then informed the addition Zoloft to her medication.

    During the last visit 11/7/2020, Mrs Jones had bifrontal headache with painful eye movement worse on the right and double vision as well as bulging of the right eye. There was preceding history of upper respiratory tract infection.
    Physical examination was normal though there was ptosis without eye protrusion. It is noteworthy that Mrs Jones’ mother also had migraine and grandmother died of stroke.

    Mrs Jones requires your professional expertise to assess her current complaint, to rule out sinister causes, and to devise the next line of management.

    Kindly contact me for further information.

    Dr Wale

  51. Dr Grace Parker .
    Consultant Neurologist /
    Newton Hospital.
    Dear Dr Parker .
    I am writing this letter to refer to you this female patient who works as a medical receptionist that is complaining a right eye ptosis as a medical complaint and she will need further urgent
    neurological asessment under yours services .
    She is a married woman with two children and lives with her husband . She has a family history of migraine on her mother and stroke in her grand mother , she is having a history of recurrent migraines attacks for several weeks and was treated since january 1997 to present time , on 1998 was treated as well . OTC ibuprofen medication were given in the past without relieves and vicodin were usedd as well with relevant improvement , last year 2020 she had depresion and was treated with zolof and her migraine was improved as a chronic condition. Now she has blurred vision for 3 days with severe bifrontal headaches , on the last week she had an URTI .
    On physical exam she has ptosis on the right eye, unable to follow orders with the sight , double vision , her general exam and rest os the neurological examinations were unremarkable , your further management and asessment would be higly appreciate , do not hesitate to contact me for more information if you have more queries and please , if is possible for you to send me a feedback of the final diagnoses it will be really appreciate a lot .
    Best regars to you .
    Sincerely .
    Dr Ricardo Saro Oliva.

  52. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11.07.2020

    Dear Dr Parker

    RE: Mrs Karen Smith
    DOB: 10.06.1975

    Thank you for seeing Karen, a 45-year-old medical receptionist, presented today with acute on set headache associated with visual disturbances and ptosis of the right eye.

    Karen came to my clinic today with a 5 day history of bi frontal severe headache with reduced visual acuity. She complaints of blurring of vision for 3 days. She also complains difficulty in moving the right eye with pain while moving both eyes where the right side being more affected than the left. She has diplopia of both eyes. There are no symptoms suggestive of an infection. However, Karen gives a history of a URTI two weeks prior to this condition.

    On examination, she is mildly febrile and her respiratory and cardiovascular functions are stable. Only abnormality that I found is right eye ptosis without protrusion. Neurological examination is normal. There are no signs of eye infection as well.

    Karen is overweight with a BMI of 31. She is diagnosed of having Migrain since 1997 and is in good control without any acute episodes for last 9 years. She also has depression and is on treatment since 2010. She is currently on Zoloft 50mg. Keren’s mother has Migrain and her grandmother died from a stroke.

    I am very much graetfull if you could assess Keren’s acute neurological condition at your earliest convenience.

    Please do not hesitate to contact me for any quaries.

    yours sincerely

    Doctor

  53. 19/09/2021
    Dr Grace Parker
    Consultan Neurologist
    Newtown Hospital
    Newtown

    Dear Dr Parker,

    Re: Mrs Bx, DOB: X/X/X

    I am writing to refer Mrs Bx into your care.Who has ptosis on her right eye and requires urgent neurological assessment.
    On 11/07/2020 Mrs Bx presented with decreased vision over computer office, blurred vision for 3 days associate with severe bifrontal headache and double vision in both of her eyes.She has reported painful movement in both of her eyes, more intense at the right eye. Her husband has noticed bulging on her right eye. She suffered from respiratory tract infection last week ago. On physical examination she has right eye ptosis, and difficulty to move her right eye, neurological examination was normal.
    Please note that Mrs Bx has medical history of migraine and depression, her current medication are ibuprofen and Zoloft.
    It would be appreciated if you could do an urgent neurological assessment to Mrs Bx and provide her further treatment and care if it will be necessary.
    If you have any question, please do not hesitate to contact me.
    Yours sincerely,
    Doctor.

  54. 20/7/2020

    Dr Grace Parker
    Consultant neurologist
    Newtown Hospital
    Newtown

    RE: Mrs XXX, Age

    Dear Dr Parker,

    I am writing to request a urgent neurological assessment for Mrs XXX with right eye ptosis.

    She is married with 2 children and lives with her husband. She has family history of migraine and stroke. She had first attack of migraine in 1997 presented with vomiting and aura the preceded by photophobia. Pain controlled by Ibuprofen – Vicodin 50 mg till now. She is diagnosed depression since 2010 and started Zoloft 20mg.

    Last week she was recovered from URTI. But today, she complaint of severe bifrontal headache for 5 days followed by blurred vision in recent 3 days. She felt painful movement of both eye and unable to move RT eye afterwards. Her husband noticed bulging of her right eye.

    On physical assessment, her vital signs and systemic exam is normal. No signs of eye infection noted. But she was found her right eye ptosis.

    Given the above, it would be greatly appreciated if you could arrange an urgent neurological assessment for this lady.

    Should you have any further inquiries, please do not hesitate to contact me.

    Yours sincerely
    Doctor

  55. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    23.09.2021
    Dear Dr Parker,
    Thank you for seeing Ms XYZ,a female medical receptionist,who requires urgent neurological assessment for severe bifrontal headache which on pain evaluation is 5/7 and right ptosis.
    Ms XYZ is complaining of decreased vision specially while working on computer and also describes double vision in both eyes.Besides this she is having painful eye movement(more at right eye).
    Ms XYZ is a patient of migrane since 1997 for which she is taking Ibuprofen 50mg.Apart from this she is on antidepressants i.e. Zoloft 20mg.Her mother was also a migrane patient.she lives with her husband and two children.She doesn’t smoke but drinks accasionally.Her BMI is 31 and is not allergic to anything.
    I would be grateful if you could see Ms XYZ for neurological assessment.If you require any further information,please do not hesitate to contact me.
    Yours sincerely,
    Doctor

  56. September 26,2021

    Dr Grace Parker
    Consultant Neurologist
    Newtown hospital
    Newtown
    July 11th 2020
    Re:Mrs x ,DOB xxx
    Dear Dr Parker,
    I am refering Mrs X working as receptionist married living with family , complains of right eye ptosis for urgent neurological evaluation.
    She presented to me on 11th july 2020 with complaints of blurred vision since 3 days.She also experienced severe bifrontal headache not like migraine which she already had since She gets pain while moving here both eyes however its more on right side.she also felt double vision from both the eyes.Her husband even noticed bulging ofher right eye.She dose’nt have any other associated symptoms like fever,neck stiffness,sob,vomiting ,joint pain or any ear symptoms.
    Her past medical history is diagnosised with migraine on regular medication since january 1997 and depression since oct 2010
    her grandmother died of stroke
    her vitals are quite stable and neurological examination positive for right ptosis
    kindly evaluate her do further neurological examination.Find free to contact me for further clarification.Thanking you

  57. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11.07.2020

    Dear Dr. Parker

    Re: Mrs. Alison DOB- 20.07.1976

    I am writing to refer Mrs. Alison , a 45-year-old medical receptionist who has severe headache, double vision and right eye ptosis. She needs your urgent neurological assessment and further management.

    Today Mrs. Alison presented to the clinic with a severe bi-frontal headache 5 days and blurred vision for 3 days duration. She also complained of double vision and painful movement in both eyes which is more in right side. In addition she is unable o move the right eye. However, she does not have any symptoms and signs suggestive of meningitis.
    On examination, her vital signs are stable and she is obese with a BMI of 31. Moreover, she has a ptosis in her right eye without any protrusion and her rest of the examinations including neurological examination are normal.
    Please note, she has been treated for migraine since 1997 and for depression in 2010. she has a family history of migraine and stroke. In addition she is a non smoker and drinks alcohol occasionally.
    Given the above, your urgent assessment and expert opinion would be highly appreciated.
    Should you have any queries, please do not hesitate to contact me.

    Yours sincerely
    Doctor.

  58. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    29/09/2021

    Dear Dr Parker,

    Re: Mrs X

    I am writing to refer Mrs X, who demonstrates symptoms of a right eye ptosis and requires urgent evaluation of her condition.

    Mrs X presesnted on 10/01/1997 with complaints of a headache and multiple episodes of vomiting. Her symptoms were preceded by a 2 day history of photophobia and phonophobia. Considering typical course of her symptoms, Mrs X was diagnosed wtih migraine and commenced on ibuprofen-vicodin 50 mg.

    On the subsequent visits, Mrs X symptoms has improved. Upon her examination, symptoms consistent with depression were detected and she was prescribed Zoloft 20mg

    On reassessment today, Mrs X suffered from severe bifrontal headache and and blurred vision

  59. Dr Grace Parker
    Consultant Nephrologist
    Newtown Hospital
    Newtown

    Date
    Dear Dr Parker,
    Re:
    I am writing to refer a patient,medical receptionist,and mother of two children who came to my clinic with sever headaches on both frontal lobes for your further neurological assessment urgently.

    She has been experiencing blurring of her eyes while watching computer screen ,intolerable headaches and incapable of moving right eye because of pain in ocular movement.Although she had upper respiratory tract infections recently,there was no symptoms consistent with increased intracranial pressure and meningitis.His husband also aware of right eye swelling.On examination,vital signs and other systems were quite unremarkable.However,right eye ptosis was observed.

    Regarding past medical history,she suffered from migraine with aura in 1997 and took Vicodin 20 mg.In next year 1998,the attack was occurred and Vicodin dose was increased to 50 mg.More than ten years later when the time she followed up,her migraine was resolved.She seemed to depressed and was prescribed by Zoloft 20 mg and Vicodin 50 mg.Her mother also had history of migraine attacks.

    It would be appreciated if you could see this patient to assess her neurological problem and further management.

    Yours sincerely,
    Doctor

  60. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11/07/2020
    Dear Dr. Parker

    Thank you for seeing Mr. (…) a medical receptionist who is suffering from recurrent headache. I am writing you a referral letter for a complete neurological assessment.
    She presented to me on 10/01/1997 reporting 30 min of headache accompanied by vomiting 4-5 times a day, in addition to 2 day history of aura with a 3-5 min of duration, precede by photophobia and phonophobia, my provisional diagnosis was migraine,so I prescribed vicodin 20 mg. After 2 year, she continued presenting migraine attacks, therefor I increased vicodin, added ibuprofen, and after that, the symptom start to improve. Back them her mood was found to be low , I managed to begin with Zoloft 20 mg in order to target a possible depression.
    Important to notice, that on examinations were found diplopia,there was a ptosis on her RT eye which was not able to move. The intent to move her eyes elicit a painful bilateral headache different for the primary one. the rest of neurological exam was irrelevant. Notice that her mother had migraine and her grandmother die of strocke.
    I would greatly appreciate you to provide Ms … with urge neurological assessment and any neurological test that aid to find a accurate diagnosis. If you require any other information do not hesitate to contact me .
    your sincerely
    Dr. Riveron

  61. Dr. Grace Parker
    Neurologist
    Newtown Hospital
    Newtown

    11/07/2020

    Dear Dr Parker
    Re: Ms. Sofia Welsh, DOB: 12/09/1993

    I am writing to refer Ms. Welsh a patient with a right eye ptosis, for urgent evaluation.

    On 11/07/2020 she came to my practice with three days of decreased vision and severe bi-frontal headaches different from those she had suffered before. Her eye examination revealed restricted and painful mobility of her eyes due to pain, more severe in her right eye.

    Ms. Welsh had migraine attacks in 1997, for which she used ibuprofen plus oxycodone, with improvement. She has not had one migraine attack since 2010. She also has depression and is currently taking 20 mg of sertraline once daily.

    Because of the findings in her eye examination, I would appreciate it if you could give Ms. Welsh an appropriate diagnosis and perform a complete neurological assessment to avoid severe complications.
    Please do not hesitate to contact me if you need any further information
    Yours sincerely,
    Michelle Farinango MD.

  62. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown
    03/10/2021

    Dear Dr. Parker,
    RE: Patient for neurological assessment urgently
    We shall be obliged if you could see this patient on an urgent basis for a neurological assessment for her recent onset ptosis of her right eye.
    This lady has been visiting our clinic since 1997 and has been under treatment for migraine, with ibuprofen and Vicodin, which resolved spontaneously by 2010. At that time she was diagnosed with depression and was advised Zolten 20.
    On 11/07/202 she presented to us with a 3-day history of sudden onset bifrontal headache associated with blurring of vision. She recognised the headache as being dissimilar to her migraine. On examination, she had ptosis of her right eye with painful movements of the eyes, especially on the right side. However, she had no constitutional features and her systems examination was normal. We could not see any indications of eye infection either.
    Considering the clinical picture, we would like to send her to you for an urgent neurological assessment.
    Please do contact me if you have any queries.
    Yours sincerely,
    Doctor

  63. Dr. Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11th July 2020

    Dear Dr. Parker

    Re: Rebecca Jones; DOB: 6 Aug, 1954

    Thank you for seeing Mrs Jones, a 67-year old medical receptionist. She is being urgently referred to you for a neurological assessment.

    Mrs. Jones first presented in 1997 with complains of a headache , which lasted 30-min in duration and was not responsive to Ibuprofen. She also had vomiting and a 2-day history of photophobia and phonophobia, followed by an aura lasting 3-5 mins. She was diagnosed with migraine and prescribed Vicodin (20 mg).
    ‘The next year, she had another migraine attack and her vicodin dose was increased to 50 mg. Over the course of time, she had no further attacks. In 2010, she was diagnosed with depression and Zoloft 20 mg was added to her medications.
    Today, she presented with severe bilateral headache and bilateral diplopia. Other symptoms include a 3 day history of blurring/ decreased vision, painful and difficult movement of both eyes, which is more pronounced in the right eye, and right eye swelling. Her symptoms were preceded by a viral infection a week ago and are different from her previous attacks. Examination reveals Right sided proptosis. The rest of her neurological examination is unremarkable.

    I would highly appreciate if you can further assess this patient. Please do not hesitate to contact me for any further information.

    Yours sincerely,

    Dr. Maheen Tariq

  64. Dr. Grace Parker
    Consultant neurologist
    Newtown hospital
    Newtown

    12/10/2021

    Dear Dr. Parker
    Re: Mrs. ————. DOB: XX

    I writing to refer Mrs. XX , XX years old, married into your care, who has ptosis in the right eye.
    Her condition requires urgent neurological evaluation and further management.

    On 11/07/2020, Mrs.XX presented complaining of decrease vision and blurred vision since 3 days, start when she’s working in her computer office associated with sever bifrontal headache 5/7 on pain scale. In addition she’s cannot moving her right eye accompanying with bulging in it. She’s reported painful movement of both eyes especially the right eye. Furthermore, double vision in both eyes.

    On 10/01/1997, she had headache last for 30min with history of photophobia and phonophobia. She was takes Vicodin 20mg with suspicious of migraine. On 01/02/1998, new attack of headache with migraine confirmation, ibuprofen and Vicodin Dealt with it. On15/10/2010, she was depressed but no more migraines attack. Her mother known case of migraine and her grandfather died of stroke.

    Mrs.XX lives together with husband and 2 children. She’s with no bad habits except drinking alcohol occasionally. She’s still on ibuprofen and Vicodin 50mg for her migraine, Zoloft 20mg for depression.

    It would be greatly appropriated if you kindly accept Mrs.XX into your care for neurological evaluation and management

    Please do not hesitate to contact me if you have any queries.

    Your sincerity,

    Dr. Ammar

  65. Dr Grace Parker
    Consultant neurologist
    Newtown Hospital
    Newtown

    Date :

    Dear Dr Parker
    Re : Mrs X, DOB :

    Thank you for seeing Mrs X, a medical receptionist who is presenting with symptoms of acute ophthalmoplegia in need of urgent neurological assessment.

    Mrs X, married with 2 children is a non smoker who drinks socially. She has an history of migraine headaches that was diagnosed in 1997, treated with vicodin 20mg. She was also diagnosed with depression in 2010 and has been treated with Zoloft 20mg since. Her family history is relevant for migraine (mother) and stroke (cause of death of her grandmother).

    On 11/07/2020 she complained of decreased vision, associated with diplopia and bifrontal headache without aura, but bulging of the right eye following a URTI a week ago. On examination, a right eye ptosis was noted without any other abnormalities .

    Considering the new character of her headaches and acute functional deficits of her right eye (pain on movement, ptosis) and bilateral diplopia, I am requesting your professional assessment as to a definitive diagnosis.

    Should you need further assistance, please do not hesitate to contact me.

    Yours sincerely.

    Doctor.

  66. Dr Grace Parker,
    Consultant Neurologist,
    Newton Hospital, Newton.

    11.07.2020

    Re: XXX DOB X

    Dr Parker,
    Thank you for seeing Mrs X, medical receptionist, who suffers from headache and vision problems.

    She showed today in my office with quite severe bifrontal headache (5/7), decrease of vision while using a computer and blurred vision since 3 days. She is unable to move her right eye and feels pain in both eyes with more intensity in right eye. Her husband noticed bulking of patient’s right eye. Reports that week ago she had infection of upper respiratory tract. Besides eye ptosis and fever (37.6 C) and obesity with BMI 31, no other pathologies were found on examination.

    In the past medical history Patient had diagnosed migraine attacks. First was in 1997 accompanied by vomiting and photophobia, treated with OTC ibuprofen (Vicodin 20mg). The following was one year after and since then she had no other attacks but suffered from depression treated with Zoloft and continuation of Ibuprofen (50mg).

    She drinks occasionally, does not smoke. Her mother suffered from migraine as well, grandmother died due to stroke.

    I would be grateful for neurological assessment of my patient as soon as it is possible.

    If you have any queries, do not hesitate to contact me.

    Your sincerely,
    Doctor

  67. 20-10-2021
    RE: MR X DOB
    Thank you for seeing Mr X , a 66-year-old married, who has presented with a severe headache associated with neurological signs, that need your further assessment, and management.
    Mr. X is married and has two children. He has had a long history of migraines since 1989 , he was treated with ibuprofen and Vicodin, but he doesn’t have any bouts OF migraines for the last 10 years. please note that his father has also migraine. Mr x is not a smoker but he is drinks socially. He has no known
    Today, Mr X presented with a severe headache, blurred vision, decreased visual acuity, and painful movement of his eyes for three days, He mention that it is not like a migraine.
    as well as, diplopia.
    His physical examination showed ptosis of the right eye without protrusion, and all other examinations for chest, abdomen, heart, and CNS were normal
    His blood pressure 123\80. Heart rate 88, temperature 36.5, and Pso2 100.
    For all of the above, I would appreciate your further investigation and tests for the final diagnosis of Mr X condition . For any further inquiries, please contact me .
    Yours sincerely,
    dr Saleem

  68. Dr Grace Parker
    Consultant Neurologist
    Newton Hospital

    23rd October 2021

    Dear Dr. Grace
    Re: Patient

    Thank you for seeing the patient, the medical receptionist, who presented with the severe bifrontal headache associated with blurred vision, unable to move the right eye, and needs further assessment.

    The patient has a history of drinking alcohol, however; does not smoke, and also has a positive family history of migraines.

    On 10/01/1997, the patient was diagnosed with migraine as he presented with headaches which lasted for 30 minutes associated with 4-5 episodes of vomiting and had aura for 3-5 minutes which exacerbated with photophobia. He has been prescribed 20mg of Vicodin.

    The patient later followed up with a migraine attack on 01/02/1998 where his medication (Vicodin) dose was switched to 50mg and the patient improved however he was diagnosed with depression and was prescribed Zoloft 20mg.

    After almost 10 years the patient had symptoms that were suggestive of a neurological issue as the patient had right eye ptosis, double vision in both eyes. Therefore, I am referring the patient for a specialist review and management.

    Yours Sincerely

    Doctor

  69. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    25/10/2021

    Dear Dr Parker,

    I am referring this female medical receptionist who presented with an acute onset of headaches, impaired vision and limited eye movement, signs suggestive of underlying cerebral pathology, for urgent neurological assessment and management.

    On an initial visit 11/07/2020, she complained of having blurry vision for the last three days and severe bifrontal headaches. In addition, she was unable to move her right eye due to pain and also experienced double vision. Furthermore, her husband noted a bulging of her right eye. Moreover, the patient reported that the current symptoms were different from her usual migraines. On examination, her vital signs were within range except for a slightly increased temperature (37,6). In addition, ptosis of her right eye was noted. However, the remaining physical and neurological evaluation was unremarkable.

    The patient has a history of migraines and depression, along with a family history positive for migraines and stroke. In terms of risk factors, she is overweight but does not smoke.

    Regarding her condition, it might be of interest that the patient just recovered from an upper respiratory infection.

    Given the above, I believe the patient requires your immediate attention. Your professional expertise would be greatly appreciated.

    Yours sincerely,

    Doctor

  70. Dr Grace Parker
    Neurologist
    Newton Hospital

    Dear Dr Parker,

    RE: Karla Santos
    DOB: 05/10/1984

    Mrs Santos, female patient, 38 years old, medical receptionist. I am writing to refer this patient with a hypothesis diagnosis of neurological disease.
    Patient with antecedent of migrane with aura, started a 3 days ago with bifrontal headache, different of previously migranes, ptosis, blurry vision, diplopia, decrease of visual acuity and proptosis on the left eye. Patient doesn’t have signs of meningism or central nervous system irritation or compress, absence of signs of infection, but she has a history of upper respiratory infection 1 week ago.
    I would like to ask you a urgent neurological evaluation, as your convenience. If you need more information, please let me know.

    Sincerely,
    Dr. Papp

  71. Dr. Grace Parker
    Consultant Neurologist
    Newtown hospital
    Newtown
    11/07/2020

    Dear Dr. Parker
    Re: patient X, DOB:
    I am writing to you to request your urgent neurological consultation and assessment for my patient-X. She has blurry vision, ptosis, painful eye movement and sever bifrontal headache.

    Mrs. X presented today to my office complaining of sever bifrontal headache 5/7 and decreased blurry vision on both eyes, painful eyes movement, and unable to move the right eye over the past 3 days. Her husband added that he noticed bulging of the right eye. she said that the headache is different than migraines attacks she had before in 1997\1998 which was treated with ibuprofen and vicodin50mg back then. she has no fever, neck stiffness, nausea or vomiting. on examination there is ptosis in the right eye but no protrusion or signs of eye infection or ear infection, vital signs are within normal -except for overweight with BMI: 31- her neurological examination otherwise is unremarkable. Patient mentioned an upper respiratory infection a week ago.
    Patient was treated for depression in 2010, in her family history her mother suffered from migraine too and her grandmother died of stroke. she is a lifetime non-smoker and drinks alcohol occasionally, with no known allergies.
    Your urgent neurological assessment and consultation for Mrs. X are highly appreciated,
    if you have any questions, please do not hesitate to contact me.
    your sincerely
    Doctor

  72. Dr.Grace Parker,
    Consultant Neurologist,
    Newtown Hospital, Newtown.

    11/7/2020

    Dear Dr.Parker,
    RE: Mrs X , D.O.B : xx/xx/xxxx

    I am writing to refer Mrs. X for urgent neurological assessment and management because of her right eye ptosis.

    Mrs. X presented with a severe bifrontal headache for 5 days prior to blurry vision for 3 days. She was unable to move her right eye due to pain and was noted to be having right eye swelling. She also complains of double vision in both eyes. A week ago, she had an upper respiratory tract infection. Her neurological examinations were unremarkable other than right eye ptosis with normal vital signs.

    Mrs. X is an occasional drinker with a strong family history of migraine and stroke. She was treated for migraine and depression in 1997 and 2010.

    I would feel grateful if you could do an urgent assessment and provide further management on Mrs. X. Please do not hesitate to contact me if you need any further assistance.

    Your sincerely,

    Doctor.

  73. Dr Grace Parker
    Consultant Neurologist
    Newtown Hospital
    Newtown

    11 July 2020

    Dear Dr. Parker,

    Thank you for seeing this female medical receptionist and mother of 2 children who requires an urgent neurogical assessment and managment.

    On today visit Mrs XX complaining about decreased vision while she was working on her compture office and double vision in both eyes. In addition, she had blurred vision for the previous three days. This was followed by a severe bifrontal headache rated 5/7 different to migraine. She was unable to move her right eye and her husband noticed that her right eye was bulging. On examination revealed ptosis in the right eye without any infection or protusion. Her vital signs were normal and her BMI was 31. However the rest of the findings were unremarkable.

    Mrs XX has been diagnosed with migraine in 1997 and depression in 2010 which she is taking Vicodin 50mg and Zoloft 20mg. She has a strong family history of migraine such as her mother. She is non smoker but she is occasional drinker.

    I would appreciate your urgent attention to her condition.
    Please do not hesitate to contact me if you need any further information.

    Yours sincerely,
    Doctor X

  74. Admitting Officer
    Emergency Department
    Newtown Hospital

    Dear Sir/Madam,
    Re:Ms Sally McConville, aged 38 years

    13/09/2014

    Thanks for seeing Ms McConville.

    I reviewed Ms McConville in my clinic today for her follow-up checkup.According to her she has more shortness of breath despite being taking prednisolone and antibiotics which I prescribed her on her last visit one day ago, and that she feels her fever has increase and she feels more unwell.On examination she had shortness of breath at rest, her respiratory rate was 25, she had obvious use of accessory muscle and increased work of breathing.Her pulse was 112,B.P was 100/65 temperature 37.5.Her chest examination showed widespread wheeze and bibasal crepitations.I made an assessment of acute asthma and prescribed her Ventolin Nebules (salbutamol) 5 mg and reviewed her after 15 minutes.After 15 minutes I didn’t noticed any recovery and that she was still in respiratory distress.

    Ms McConville past medical history include Asthma,Hypertension and Depression.She is on ramipril 2.5 mg daily, paroxetine 20 mg daily, fluticasone 250-2 puffs daily, Ventolin (salbutamol) 2 puffs if required.

    3days ago Ms McConville presented to my clinic with a two day history runny nose, productive cough with yellow sputum, low grade fever, no shortness of breath.Her asthma is usually well controlled on preventer (fluticasone 250-2 puffs daily).On examinations she had obvious nasal congestion, red throat and chest scattered wheeze.I made an assessment of upper respiratory tract infection/infective exacerbation of asthma and prescribed her Ventolin 2 puffs -4 hourly and continue using preventer.I also issued her a medical certificate for work and to come for review if require,After 2 days she came to my clinic and her condition was further deteriorated with increased shortness of breath and wheeze over past 24 hours, feeling feverish sometimes, minimal yellowy sputum and shortness of breath on minimum exertion.On examination her throat was red, mildly increased work of breathing and chest examination shows widespread wheeze with temperature 38,pulse 95 and respiratory rate 16.I made an assessment of infective exacerbation of asthma and prescribed her amoxicillin 500 mg 3 times daily, prednisolone 25 mg 3 times daily and to continue using 4 hourly Ventolin and preventer.

    Ms McConville is single and works as an administrator.She doesn’t smoke and has no known allergies.Her past surgical history includes cholecystectomy and ankle fracture surgery.

    I will appreciate if you could review Ms McConville for acute management and investigate her for pneumonia.If you need further information please do not hesitate to contact me.

    Yours sincerely,
    Doctor

  75. 03/12/2021

    Admitting Officer
    Emergency Department
    Newtown Hospital

    Dear Doctor

    Re: Sally McConville (Ms), 38 years old

    I would like to refer Ms McConville under your kind supervision for further evaluation and management with his ongoing difficulties with acute of exacerbation of asthma and possible pneumonia.

    Ms McConville was reasonably well 4 days back with her significant past medical history of asthma and hypertension. Then she suddenly developed an episode of suspected viral upper respiratory tract infection. In the meanwhile, all the supportive treatment was provided with supervision.

    However, Ms McConville’s condition subsequently more deteriorated and she developed fever, shortness of breathing, productive cough and effort intolerance. Her treatment was revised according to the protocol.

    Despite of all the standard medications, her health condition progressively worsened as evidenced by unstable vital statistics and increasing breathing workload. It is to be noted that she is neither smoker nor allergic to medications.

    With above all the features, I am referring Ms McConville under your professional assistance for future management and evaluation.

    It would be immense pleasure if you would contact me for any information regarding health issues of Ms McConville.

    Yours Sincerely in
    Doctor

  76. Admitting Officer
    Emergency Department
    Newtown Hospital

    13/9/14

    Dear Doctor,
    Re: Ms Sally McConville, aged 38

    I am writing to refer this patient who has provisional diagnosis of asthma complicated with pneumonia for urgent management.

    Ms McConville has asthma controlled with fluticasone regularly and Ventolin if required. On 10/9/14, she presented with runny nose, productive cough with yellow sputum, mild fever and wheezy suggestive of upper respiratory tract infection and deteriorated asthma. The vital signs were stable. She was advised to increase the usage of Ventolin. Two days later, the conditions deteriorated with fever and shortness of breath on minimal exertion. Oral amoxicillin and prednisolone were commenced for diagnosis of infection exacerbation of asthma.

    On today’s review, she presented with shortness of breath at rest, accessory muscle use, bibasal crepitations and widespread wheeze. Hypotension (100/65 mmHg), tachycardia (112 per minutes), and tachypnea (25 bpm) were noted. After 15 minutes use of Ventolin Nebules, the conditions didn’t improve.

    I would appreciate it if you could provide urgent investigation and management for Ms McConville’sconditions. Please note, she has hypertension and depression controlled with ramipril and paroxetine.

    If you have any queries, please don’t hesitate to contact me.

    Yours sincerely,
    Doctor

  77. Doctor
    Admitting Officer
    Emergency Department, Newton Hospital

    12/8/2021

    Dear Dr,
    Re: Ms Sally McConville, 38 year old

    I am writing to urgently refer Ms Sally for her worsening asthma exacerbation and to rule out the possibility of pneumonia. Ms Sally requires your immediate evaluation and management.

    On today’s review, Ms Sally’s shortness of breath has increased despite taking oral steroids, antibiotics, and asthma medications (Ventolin and Fluticasone inhaler). On examination, she was showing signs of distress with widespread wheeze and bibasal crepitations on chest auscultation. She was given Salbutamol nebulization which afforded no relief of her symptoms.

    Ms Sally initially presented 3 days ago with symptoms consistent with infective asthma exacerbation and was advised to start Ventolin inhaler 2 puffs every 4 hours, and to continue her preventer medications (Fluticasone 250mcg 2 puffs daily). She was then reviewed yesterday and was noted to have persistent symptoms. Hence, she was started on Amoxicillin 500mg three times a day and Prednisolone 25mg once daily for 3 days.

    I would be grateful if you could provide acute asthma management with further investigation of a lower respiratory tract infection. Should you have further queries please contact me.

    Yours respectfully,
    Doctor

  78. Admitting Officer
    Emergency Department
    Newtown Hospital

    13/9/2014

    Dear doctor
    Re: Ms Sally McConville(aged 38)

    Thank you for admitting Ms Sally McConville, a 38-year old asthmatic patient with an episode of respiratory tract infection with respiratory distress.

    Ms McConville came on 10th of September with a 2-day history of upper respiratory tract infection, including rhinitis, cough with yellow sputum and a slight fever. She was wheezy but without shortness of breath. The asthma was well controlled. On the examination RR was 12, BP was normal, body temperature was 37.5°C. I prescribed Ventolin 2 puffs 4-hrly and to continue the preventer if needed(Fluticasone 250 2 puffs daily).

    The patient returned on 12th of September with the worsening of the symptoms: shortness of breath and wheezing increased, linked with a minimal exertion. She still had yellow sputum, subfebrile temperature. Her body temperature was 38.0°, HR 95, BP 120/80, widespread wheeze without crepitations. I suspected infective exacerbation of asthma and prescribed Amoxicillin 500 mg 3x daily, prednisolone 25 mg daily 3 days and to continue the previous treatment.

    Ms Sally McConville returned the next morning with increased shortness of breath despite the treatment. On the examination I revealed short of breath at rest, RR 25, pulse 112, BP 100/65, temp 37.7°C, bibasal crepitations and widespread wheeze. Ventolin Nebules 5 mg was prescribed, but there were no improvement during 15-20 minutes after the treatment.

    MS McConville has a history of asthma and hypertension. Earlier she had cholecystectomy, ankle fracture and depression. She doesn’t smoke, no allergies.
    The patient takes ramipril, paroxetine, fluticasone 250 mg 2 puffs daily and ventolin 2 puffs if required.

    I am writing to you to send the patient to your Department for further care.

    Do not hesitate to contact me for any queries if needed.

    Sincerely yours,
    Doctor

  79. The Admitting Officer
    Emergency Department
    Newtown Hospital

    13/09/2014

    Dear Doctor
    Re : Ms Sally McConville, aged 38

    Thank you for seeing Ms McConville, whose clinical manifestations are suggestive of pneumonia. Your urgent assessment and further management would be highly valued.

    On today’s review, Ms McConville presented at my clinic with progressive shortness of breathing although she takes the previously described prednisolone and antibiotics regularly . On examination, respiratory distress signs were revealed and her chest auscultation showed widespread wheeze and bilateral basal crepitations. Thus, Ventolin nebulizer, 5 mg was commenced. Fifteen minutes later no improvement was noticed.

    Three days later, Ms McConville has experienced symptoms and signs concomitant with
    viral upper respiratory tract infection, for which she Ventolin 2 puffs every 4 hours was commenced. Yesterday, she attended my practice with a one-day history of increasing shortness of breath with minimal exertion. Upon assessment, apart from tempareture reading of 38, mildly increased work of breathing and widespread wheeze, no other abnormalities were detected. She was advised to continue on the same dose of Ventolin. Additionally, Amoxicillin, 500 mg and Prednisolone, 25 mg three times daily were prescribed.

    Ms McConville has history of bronchial asthma and hypertension and she takes the appropriate medications for them.

    In view of the above-mentioned data, i would appreciate your attention to his condition. Should you have any queries, please do not hesitate to contact me.

    Yours faithfully
    doctor

  80. Dear ED
    RE: Ms. Sally MConville, aged 38

    I am writing to refer Ms. MCconville, a 38-year-old administrator, for an urgent management and investigation of her worsening acute Asthma exacerbation secondary to pneumonia.

    Ms. MCconville initially presented to the clinic on 10/9/14 with yellowish productive cough and wheezing with no symptoms of dyspnea or respiratory distress. However, three days later, Ms. MCconvile symptoms have progressively worsens. She is in significant respiratory distress with worsening shortness of breath at rest. Her vital signs were deranged with RR 25/min, BP 100/65mmHG, Temp. 37.7 and pulse 112/min. On physical examination, there was wheezing bilaterally, bibasal crepitus and use of accessory muscles.

    Ms MCconville was treated with Amoxicillin 500mg, Po, TID and Prednisolone 25mg, Po, TID initially and Ventolin nebulizer 5mg subsequently. Nevertheless, her symptoms are progressively getting worse. She is a non-smoker with no known allergy. She has a history of well controlled Asthma and hypertension. Her home therapy includes fluticasone 250mg, 2 puffs daily, Ventolin 2 puffs daily and ramipril 2.5mg, daily.

    I would appreciate it, if you could evaluate and provide a treatment plan for Ms. MCconville. If you have further question, do not hesitate to contact me.

    Yours sincerely,
    Doctor.

  81. date:
    To,
    Admitting Officer,
    Emergency Department,
    Newton Hospital,
    Newton.
    Re: Ms. Sally McConville, aged 38
    Dear Doctor,
    I am referring this patient who was diagnosed with Asthma for urgent management of her symptoms and further investigation.
    On 12/9/14 patient presented with a 2 day history of productive cough,He was asthmatic which was well managed by the preventer. On examination, He was diagnosed with viral URTI and infective Exacerbation of Asthma for which he was prescribed ventolin (2 puffs every 4hrs) along with his usual preventer.
    Two days later patients condition was detoriated and he has prescribed Amoxicillin (500mg) and prednisolone (25mg) which did not help either.
    Today at 10:30 am he was having difficulties in breathing. His respiratory rate was 25/min. on Auscultation bibasal crepitations and wheezing was heard. He was given Salbutamol (5mg) and still there is no progress in the patients symptoms.
    Ms. Sally McConville is a Non-Smoker and has a history of Asthma, Hypertension and Depression.
    No improvement in the symptoms and Respiratory Distress and Pneumonia is supected. So it would be very kind of you to assessand manage the patients symptoms and further investigations.
    Note: She has no known allergies
    You can contact us anytime should you need any further information
    Thanking you
    Doctor

  82. Admitting officer,
    Emergency dept,
    Newtown Hospital.

    14th jan, 2022.

    Dear officer,
    Re: Sally Mc Conville, 38 years old.

    This pateit is presented with runny nose, wheeze , preductive cough and fever. He has the history of asthma that normally is well controlled with fluticasone and ventolin puffs. He has no history of allergy. He was given amoxicillin, predinisolone and ventolin but there is no improvement. He is still having shortness of breath at rest , crepts and wheeze. It is suggested that he hashas infected exacerbation of asthma. He is referred for further management and investigation of his cause.
    Thank you.

    Sincerely,
    Dr. Nida

  83. Emergency Department Admitting Officer
    Newton Hospital

    17th January 2022

    Dear Doctor,
    Re: Miss Sally McConville, aged 38

    Thank you for seeing Miss McConville in such short notice, for acute management and continued investigation of her exacerbating and debilitating respiratory symptoms.

    Miss McConville has a medical history of asthma, hypertension, ankle fracture, depression, and a surgical history of cholecystectomy. Her medications include Ramipril 2.5mg daily, Paroxetine 20 mg daily, Fluticasone 250-2 puffs daily, and Salbutamol 2 puffs if needed.

    On 10/9/14, she presented with a 2-day history of runny nose, yellow sputum cough, fever, and physical exam revealed scattered wheezing. At that time, symptoms were treated as viral and Ventolin was changed to 2 puffs every 4 hours and symptoms were reviewed. Two days later, she presented with increased shortness of breath on minimal exertion and worsening wheezing. Examination revealed a red throat, increased work of breathing, and widespread wheezing, and treated as an infectious asthma exacerbation. She was started on Amoxicllin 500 mg 3x daily, and prednisolone 25 mg daily x 3 days.

    Today she continues to worsen despite medical management, with visible deconditioning, respiratory distress, and unstable vitals. Exam shows wheezing bibasal crepitations, mild fever, tachypnea, and tachycardia. Therefore, she is being referred to the ED for further management.

    Sincerely,

    Dr Jimenez

  84. Dear XXX,

    Re: Sally McConville, aged 38

    I am writing to request acute management for Ms McConville, an asthmatic patient, who is in respiratory distress. I am concerned that she is experiencing symptoms consistent with pneumonia.

    Ms McConville first presented on 10/9/14 complaining of a 2-day history of symptoms indicative of a viral respiratory tract infection. Examinations were unremarkable other than nasal congestion, red throat and scattered wheezes. However, her condition deteriorated in the following days as she was experiencing increased dyspnea and wheezing on minimal exertion.

    This morning, she was feverish and unwell with worsening shortness of breath despite treatment with prednisolone and antibiotics. Chest examination revealed widespread wheeze with bibasal crepitations. There was increased work of breathing with accessory muscle use. Her respiratory rate (25) and pulse (112) were elevated, and blood pressure had dropped (100/65). Ventolin Nebules 5mg was initiated. Despite treatment, there was still no improvement after 15 minutes.

    Ms McConville has asthma, hypertension and depression for which she is currently taking ramipril, fluoxetine, flucatisone and Ventolin. She has no known allergies.

    I would be most grateful if you could assess Ms McConville’s condition to confirm the preliminary diagnosis and provide her with ongoing care.

    Yours sincerely,

    Doctor

  85. Admitting officer
    Emergency department
    Newton hospital
    date
    dear,Admitting officer
    re;sally mc convilla[38 years]
    Thanks for seeing mrs sally known asthmatic with acute exacerbation of her asthma for further mangement.
    mrs sally is known asthmatic for which she uses inhaler fluticasone and salbutamol inhalers as required;
    mrs sally visited me on …..with acute history of upper respiratory tract infection for 2 days;i examined her and adviced salbutamol inhaler 4 hourly and provided a medical certificate;
    she revisted me 2 days back with worsening symptoms ,this time she reported sob,fever,yellowish sputum .though she was vitally stable ,however there were scattered wheezes on her chest with no crepitations;i prescribed antibiotic and prednisolone ;
    today mrs sally reported at 10;30 am with worsening symptoms again ;this time her psotive findings apart from her previous symptoms she was ,sob, tachypnic and was tachycardic ;there were wheezes and crepitations bilaterally;
    she was nebulized for 15 minutes and reviewed ,however her condition didnot improve
    i would highly appreciate if you could manage and assess her ;
    yours sincerely
    dr sami

  86. Emergency Department,
    Newtown Hospital

    13.9.14

    Dear Dr.,

    Re: Ms. McConville, aged 38

    I am writing to refer Ms. McConville, who required an urgent investigation of her symptoms, to you. She presented with a 2-day history of runny nose, productive cough, slight fever, and wheezing.

    She has a medical history of asthma which is being treated and well-controlled by Ventolin and fluticasone.

    On her first visit, her temperature was 37.5 and her vital signs were normal. On examination, nasal congestion, red throat, no other abnormal signs are revealed. They were treated with ventolin 2 puffs 4 hourly and fluticasone as her symptoms were diagnosed as viral respiratory tract infection or infective exacerbation of asthma. Two days later, she reported severe symptoms including increased work of breathing and wheezing all over both lungs. So that it started to be treated with antibiotics ( amoxicillin and prednisolone) while ventolin and fluticasone continued . Today, her symptoms are more severe in spite of prednisolone and antibiotics and for that, one nebulizer ventolin was given. However, After a few hours, her symptoms still show no improvement. It is suspected to be pneumonia. I would be grateful if you could assess her condition urgently for acute management and investigation.

    If you need any further information, don’t hesitate to contact me.

    Yours sincerely,
    Dr. Yi

  87. Admitting Officer
    Emergency Department
    Newtown Hospital

    Date: 13/09/2014
    Dear Officer,
    Re: Ms. Sally McConville

    Ms. Sally, a 38-year-old single administrator woman, is being referred to the Emergency Department for an urgent workup and further management for possible pneumonia. She is a known case of asthma, and she is often well-controlled on fluticasone 250-2 puffs daily and Ventolin 2 puff if needed.
    Ms. Sally initially presented on 10/09/2014, complaining of a two-day history of runny nose with productive cough (yellowish in color). On examination, she had nasal congestion, pharyngeal erythema and some chest wheezing, but no shortness of breath or any signs of asphyxia. She was febrile (37.5), and her respiratory rate was 16, I instituted her on amoxicillin 500mg and prednisolone 25mg 3 times a day alongside her usual medication for asthma.
    On review today, she has been deteriorating with progressive respiratory distress using her accessory muscle to breath associated with bi-basal crepitation and widespread wheezing, her respiratory rate reached 25, pulse 112, and is slightly hypotensive despite the treatment given. Ventolin Nebules 5 mg has been prescribed for her at 10.30 a.m.
    Please note that Ms. Sally is a known case of hypertension for which she uses ramipril 2.5 mg.

    I would appreciate your kind assessment and urgent treatment for this patient.
    Should you have any further queries, please do not hesitate to contact me.

    Yours sincerely,
    Doctor

  88. Admitting Officer
    Emergency Department
    Newton Hospital
    13/9/2014
    Dear Dr
    Re: Ms Sally McConville
    Thank you for urgently seeing Ms McConville, a 38-year-old administrator who I believe is suffering from acute exacerbation of asthma with possible pneumonia.
    She initially presented to my practice on 10/9/2014 with upper respiratory tract symptoms for 2 days. However, at that time she was not breathless. She was diagnosed with viral upper respiratory tract infection with infective exacerbation of asthma and commenced on Ventolin 2 puffs 4 hourly and to continue her preventer medication.
    She returned two days later due to worsening symptoms. She started to become more breathless with shortness of breath on minimal exertion. Furthermore, her work of breathing has increased. I started her on Amoxicillin 500mg and prednisolone thrice daily on top of her Ventolin and Fluticasone.
    Today, she reported no improvement of symptoms despite prednisolone and antibiotics. Upon examination, her respiratory rate is 25 with breathlessness at rest and increased work of breathing and bibasal crepitations.
    She is a known asthmatic and her medications include Fluticasone 250- 2 puffs daily and Salbutamol 2 puffs if required. Moreover, she does not smoke and has no known allergies.
    I would be grateful if you could examine her and provide your management plan as you feel appropriate. Do not hesitate to contact me in case of any queries.
    Yours sincerely,
    Doctor

  89. Admitting Officer
    Emergency Department
    Newtown Hospital

    Date: 13th September, 2014

    Dear Admitting Officer,

    Re: Ms Sally McConville , Aged 38 years

    I am writing to refer Ms McConville whose symptoms are suggestive of acute asthma with pneumonia.

    Ms McConville is 38 years old single woman and has a long standing history of asthma, hypertension and depression for which she is taking respective medications.

    On 12/09/14, Ms Mc Conville attended my clinic complaining of runny nose, productive cough, slight fever and wheezing. At that time, she didn’t experience shortness of breath and has well controlled asthma on preventer medication. Her examination was unremarkable except obvious nasal congestion and redness in throat. She was prescribed Ventolin 2 puffs 4-hrly and advised to continue preventer. Two days later, her symptoms worsened with increasing shortness of breath and wheezing. On examination, she had mild fever, mildly elevated pulse rate and rednes in throat. On chest examination she had mildly increased work of breathing and widespread wheezing. Therefore, she was prescribed amoxicilling and prednisolone and advised to continue 4-hrly ventolin and preventer.
    Unfortunately, today, her symptoms markedly aggravated despite prednisolone and antibiotics. On examination, she had mild fever, elevated respiratory rate and pulse rate along with low blood pressure. This time, she also had shortness of breath at rest and her chest examination revealed widespread wheezing and bibasal crepitations. Her symptoms and signs are suggestive of acute asthma with possible pneumonia. There was no improvement even after Ventolin nebulizer.
    In view of the above, I am referring her to emergency department for acute management and further investigations. Please contact me if you have any queries.

    Yours sincerely,

    Doctor.

  90. 13th September, 2014

    Admitting Officer
    Emergency Department
    Newtown Hospital

    Dear doctor,

    Re: Ms. Sally McConville, 38 years old

    I urgently refer to you Ms. Sally McConville, a 38 year administrator suffering from asthma who has developed severe respiratory distress due to recent respiratory infection.

    Ms. McConville initially came down to our clinic three days ago with viral upper respiratory infection without signs of her asthma exacerbation and was additionally prescribed Ventolin 2 puffs every 4 hours. The patient suffers from asthma which is well controlled with Fluticasone 250 twice daily and additionally Ventolin 2 puffs if required. Her regular medication include also ramiprile 2,5mg daily and paroxetine 20mg once a day.

    Unfortunately, her asthma exacerbated and she presented yesterday with shortness of breath followed by increased work of breathing and her respiratory rate was 16 per minute. Chest auscultation revealed wheezing and no crepitation. Consequently, amoxicillin 500mg tds and prednisolone 25mg daily were added to current medication.

    Despite all medication, Ms. McConville returned today with the signs of advanced respiratory distress syndrome, still febrile with bi basal crepitation on her chest examination. She showed no response to additional Ventolin 5mg requiring higher level of medical care.

    Thank you for your further assessment and treatment of this patient.

    Your sincerely
    Dr. Katarina Pavlovic

  91. Admitting Officer
    Emergency Department
    Newton Hospital

    13/9/14

    Dear Doctor

    Re: Ms Sally McConville, 38 years old

    Thank you for seeing Ms McConville, whose features are suggestive of acute asthma along with the possibility of pneumonia. She requires your urgent assessment and management.

    3 days ago, Ms McConville presented with a 2-day history of runny nose, productive cough with yellow sputum, fever and wheezing. On examination, her vitals were within normal limits but nasal congestion and scattered wheezing was noted. She was diagnosed with a viral respiratory tract infection and infective exacerbation of asthma, and prescribed Ventolin 2 puffs 4- hourly along with her usual preventer.

    On 12/9/14, Ms McConville reported increased dyspnea on minimal exertion and wheeze. On examination, she was febrile (38) and had increased work of breathing with widespread wheeze on chest auscultation. Therefore, she was commenced on Amoxicillin 500 mg and prednisolone 25 mg three times a day in addition to inhaler treatment,

    Today, Ms McConville’s symptoms have worsened. She is breathless at rest with a respiratory rate of 25 and has obvious use of accessory muscles for breathing. There is also widespread chest and bibasal crepitations on chest examination. She has been given Salbutamol 5 mg; however her symptoms have failed to improve.

    Ms McConville is asthmatic, for which she tales fluticasone 250 2 puffs daily and Ventolin 2 puffs when required.

    In light of the above, please provide urgent assessment and management of Ms McConville’s acute asthma, and possible pneumonia.

    Yours sincerely,

    Doctor

  92. Admitting Officer
    Emergency Department
    Newton Hospital
    15 April 2022
    Dear Doctor,
    Re: Ms Sally McConville, 38 year old
    I am writing to refer Ms McConville who is having acute infective exacerbation of asthma or possibly pneumonia who requires acute management and investigation.
    Ms McConville, single and a known asthmatic presented to me 3 days ago with runny nose, yellow productive cough, slight fever and wheezing resembling signs of upper respiratory tract infection. 2 puffs of Ventolin was recommended 4 hourly and she was advised to continue using 2 puffs of her regular asthma medication (fluticasone 250mg). Please note that she is a non-smoker.
    Ms McConville again presented two days later with worsening shortness of breath and wheezing for which Amoxicillin 500mg thrice a day and prednisolone 25 daily for 3 days was prescribed along with above mentioned treatment.
    Today, despite using all recommended treatment, Ms McConville presented again with laboured breathing with notably accessory muscle use. Her respiratory rate, pulse, blood pressure, temperature was 25, 112, 110/65 and 37.7 respectively. Widespread wheezing and bibasal crepitations were noted on chest examination. Salbutamol 5mg was given with no improvement in respiratory distress. So we have decided to refer her to emergency department.
    I would be very grateful if you could admit her for the acute management of infective exacerbation of asthma or possibly pneumonia and investigate her accordingly.
    Should you require any further information, please don’t hesitate to contact me.
    Yours sincerely,
    Doctor

  93. Admitting Officer
    Emergency department
    Newtown Hospital

    21/04/2021
    Re: Ms Sally Mc Conville, 38 years of age
    Dear Officer,
    I am writing to refer Ms Sally into your care for acute management and further investigations, who has underlying Bronchial Asthma and hypertension.
    Ms Sally initially presented with productive cough , runny nose and fever with no shortness of breath. She was given Ventolin and to review when required. Two days later, she had shortness of breath on exertion and was given Amoxicillin and a three day course of Prednisolon. Despite the Antibiotics and steriods, the symptoms were worsening.

    I would Appreciate, if you could assist Ms Sally and provide her the care needed.
    If you have any questions please do not hesitate to contact me

    Yours Sincerely

    Doctor

  94. Admitting Officer
    Emergency Department
    Newtown Hospital

    Dear Admitting Officer,
    Re: Sally McConville

    Thank you for admitting Ms McConville, 38 year-old administrator, with primary medical history of asthma, hypertension, depression who requires urgent investigations due to her asthma exacerbation possibily due to pneumonia.

    In 10 September 2014, Ms McConville presented with 2 days history of runny nose, productive cough with yellow sputum without shortness of breathe. I diagnosed with infective asthma exacerbation due to viral upper respiratory tract infection. Her symptoms were managed by ventolin 2 puffs-4 hourly. 2 days later patient presented with increasing shortness of breath and wheezing for last 24 hours with a minimal yellow sputum. she had fever (38 degree Celsius). Diagnosis was the same and I prescribed amoxicillin 500 mg 3 times a day and prednisolone 25 mg 3 times a day. Patient continued to take ventolin and prevented. Today at 10.30 am, despite prednisolone and antibiotic her symptoms got worst. On physical examination, her respiratory rate was increased (25) with the use of accessory respiratory muscle and increase work of breathing. Her blood pressure was 100/65 mmHg. On chest examination, widespread wheezing and bibasillar crackles was heard. I prescribed 5 mg Ventolin nebules (salbutamol).

    I would be grateful if you could accept Ms. McConville to Emergency department at your earliest convenience for acute management of her symptoms and further investigation.

    Your Sincerely,

    Doctor

  95. Admitting Officer
    Emergency Department
    Newtown Hospital

    13 September 2014

    Dear Doctor,

    Re: Ms Sally McConville
    Age: 38-year-old

    Thank you for seeing Ms Sally McConville, a 38-year-old lady who is diagnosed with possible pneumonia and acute exacerbation of asthma for acute management and further investigation.

    In today’s consultation Ms McConville presented with worsening of symptoms including shortness of breath, feeling feverish and unwell despite of prednisolone and antibiotics. On examination she had respiratory rate of 25, increased work of breathing, usage of accessory muscle, widespread wheeze with bibasal crepitations, pulse of 112, Bp of 100/65, and temperature of 37.7. Despite of Ventolin nebulisations, she has been suffering from respiratory distress.

    Initially on 10/09/14, Ms McConville experienced two days history of runny nose, productive cough with yellow sputum, slight fever and wheezing. Her examinations were unremarkable apart from nasal congestion and red throat. Based on working diagnosis, She has been advised to use Ventolin 2 puffs four hourly and continue Preventer 2 puffs daily. Two days later she has developed to worsening of symptoms with tempeature of 38, mildly increased work of breathing and widespread wheezing. Amoxicillin 500mg three times daily and prednisolone 25 mg three times daily has been prescribed and inhalers also increased to 4 hourly interval.

    Please note that Ms Mc Conville has a history of bronchial asthma which is usually well controlled with Preventer. She also has hypertension and depression which is treated accordingly. She is a non-smoker.

    I would greatly appreciate your urgent attention for acute management and investigation of Ms McConville’s possible pneumonia and acute exacerbation of asthma. Should you have any queries please feel free to contact me.

    Yours faithfully,

    Doctor

  96. To
    Admitting Officer
    Emergency Department
    Newtown hospital
    13th of  September,2014

    RE:Sally McConville,38 yers of age

    Dear Mr Admitting Officer

    Thanking you for seeing Ms McConville,who is apparently suffering from suspected pneumonia,and being reffered to you for urgent assesment and to admit for further treatment.

    Today Ms McCovillie presented with shortness of breath despite medications,as well as feeling of fever and unwellness.On examination she has been found to be breathlessness at rest,respiratory rate is high and using her accessory muscle to breath.Auscultation of chest reviled widespread wheeze and basal cripitations.

    On the suspicion of acute asthma she has been given ventolin nebulization,but showed no improvement.

    It is need to mention that,for the last three days she is having  cough and visiting for treatment.Though she has been treated with asthma medications,antibiotics and steroid her condition worsen.

    Regarding her past medical history it s known that she is having asthma and hypertension with regular medication of ramipril and fluticasone.Her astham is usually well controlled.She also suffered from depression,so on paroxetine  and had a operation of cholecystectomy.

    She is a non smoker,single administrator and having no allergy.

    On the view of her history and symptoms she is provisionally diagnosed as a case of  pneumonia.

    It would me highly appreciated ,if you kindly assess her condition and admit her for further evaluation and management.

    Your sincerely

    Gp

  97. dmitting Officer
    Emergency Department
    Newtown Hospital

    13-09-2014

    Dear admitting officer,
    Re: Ms Sally McConville, 38 years old

    I’am referring Ms McConville for an acute management and an urgent investigation of her respiratory distress.

    Ms McConville, asthmatic usually well-controlled on preventer, presented today at 10:30 to the clinic with shortness of breath at rest, respiratory rate 25 cycles/min, obvious accessory muscle use and increased work of breathing with tachycardia at 112beats/min. On chest examination, she has widespread wheezing and bibasal crepitations, for which she was prescribed salbutamol 5mg and was reviewed. 15 minutes later, she was still on respiratory distress which might be due to pneumonia.

    On 10-09-2014, Ms McConville presented to the clinic with 2-day history of symptoms-like infective exacerbation of asthma: nasal congestion, slight fever, cough productive yellow sputum. She was treated with: Ventolin, 2puffs 4-hourly; continue preventer (fluticasone, 250 2puffs daily), and she was asked to be reviewed.

    Two days later, she came back with worsening of her initial symptoms: increasing shortness of breath on minimal exertion and wheezing, she was prescribed: Amoxicillin, 500mg 3*daily* 3days; and to continue with Ventolin and preventer.

    I would greatly appreciate if you could admit Ms McConville in your emergency department as urgently as possible for management of her respiratory distress and for further investigation to determine a definitive diagnosis.

    If you have any queries, please do not hesitate to contact me.

    Yours sincerely,

    Doctor

  98. 13th September 2014

    Admitting Officer
    Emergency Department
    Newtown

    Dear Admitting Officer,

    Re: Ms. Sally McConville, 38-year-old

    I am writing to refer Ms. McConville who is exhibiting signs and symptoms of bronchial asthma exacerbation probably secondary to pneumonia. She is in need of further evaluation and management.

    Ms. McConville came in today due to shortness of breath and fever. She has manifested signs of respiratory distress; hence, nebulization with Ventolin was done which did not improve her condition.

    She initially presented on 10/9/14 with productive cough, colds and wheeze. Ventolin inhaler was prescribed, and she was advised to continue her Fluticasone puff. Two days after initial consult, Ms. McConville came back with worsening of signs and symptoms. Prednisolone and Amoxicillin were added to her previous medications.

    Ms. McConville has been taking Ramipril and Paroxetine for her hypertension and depression, respectively. She is a non-smoker and has no known allergies. It would be highly appreciated if you can further investigate her condition and provide intervention.

    Please don’t hesitate to contact me if you have any questions.

    Yours respectively,

    Doctor

  99. Admitting Officer
    Emergency Department
    Newton Hospital

    Date: 05 May 2022

    Dear Admitting Officer

    Re: Ms. Sally McConville, Age 38

    Ms. Sally McConville is single, with history of asthma, hypertension, ankle fracture, cholecystectomy, and depression with no history of smoking and no allergies. Moreover, he is taking Ramipril 2.5 mg OD, paroxetine 20mg OD, fluticasone 250-2Puffs OD, and Ventolin 2 puffs SOS.

    On 10-Sep-2019 she has 2-days history of runny nose, productive cough of yellow sputum, slight fever, wheezy, no shortness of breath, asthma well controlled with preventive fluticasone. On Examination she had no temperature, pulse 82, BP 120/80, respiratory rate 12, obvious nasal congestion, red throats, ears normal, no increased work of breathing, no crepitations. Assessment suggestive of URTI and and infective exacerbation of asthma. She was given Ventolin 2 puffs 4 hourly daily and continue preventor.

    On 12-Sep-2019 she developed increased shortness of breath and wheeze over last 24 hours, feeling feverish at times, and minimal sputum. Amoxilling 500mg TDS and prednisolone 25mg added TDS were added.
    On 13-Sept-2019 at 10:15 am further shortness of breath occurred with respiratory rate at 25, widespread wheeze, bibasal crepitations. Ventolin Nabulizer was started. At 10:45 am no abvious improvement occurred.

    She is being referred at your emergency department for thorough medical investigation and treatment

    Yours Sinerely,

    Doctor

  100. Dear Admitting Officer
    Emergency department

    Date: 23rd May 2022

    Dear …
    Re: Ms Sally McConville, DOB:

    I am writing to refer Ms McConville, a 38 years old female administrator who is in respiratory distress and likely to have pneumonia for admission to the emergency department for acute management and investigations.

    Ms McConville has past medical history of asthma, hypertension and depression for which she is taking ramipril, paroxetine, fluticasone daily and ventoline as required. She is a non smoker and does not have any allergies.

    Ms McConville initially presented on 10/9/2014 with 2 days of runny nose, productive cough and slight fever without any difficulty of breathing. On examination, she had clear chest. She was advised to continue ventolin four-hourly and fluticasone for viral upper respiartory tract infection and asthma exacerbation. She came next day with increased shortness of breath on minimal exertion and fever. She was also prescribed amoxicillin and prednisolone.
    Today morning she presented with worsening shortness of breath at rest despite antibiotics and prednisolone. She is in obvious respiratory distress and i am concerned she has pnemonia.

    I would really appreciate if you could admit her to the emergency department and do the needful. Should you have any queries please feel free to contact me.

    Yours faithfully
    Dr Anuradha Nath

  101. Dear Sir/Madam
    Admitting Officer
    Emergency Department
    Newton Hospital
    Newton

    12 September 2014
    Dear Admitting Officer
    Re: Sally McConville
    I am writing to refer Mrs Sally McConville urgently due to exacerbation of her treatment-resistant asthma.
    Mrs McConville has presented to our ED on 3 separate occasions. During her first and second visits on 10th and 12th September 2014 she has been complaining of cough with yellowish productive sputum but only with mild fever. She was treated with Ventolin and prednisone and sent home.
    Today at 10:30 she presented with severe shortness of breath associated with wheezing and high-grade fever. She was placed on salbutamol puffs but on assessment at 10:45, the symptoms worsened leading to respiratory distress.
    I am grateful if you could accept her into your care for her respiratory distress as her condition is rapidly deteriorating.
    If you have any queries, do not hesitate to contact me.
    Yours sincerely
    Doctor

  102. 13/09/2014
    Admitting officer
    Emergency department
    Newtown Hospital

    Re – Ms. Sally McConville
    Age -38yr

    Respected doctor, 38 year old female Ms. Sally McConville with history of asthma presented to us on 10/09/2014 with 2 day history of runny nose, cough productive of yellow sputum, fever 37.5, wheezing without shortness of breath with controlled asthma on fluticasone 250 – puff daily. On examination patient had nasal congestion with red throat and scattered wheeze with normal other vital signs. Patient was diagnosed as a case of viral infective exacerbation of asthma and was added ventolin 2puffs 4 hourly.
    On 12/09/2014 patient again presented with worsening asthma features, having developed shortness of breath in febrile condition. Respiratory rate was increased compared to previous visit 16/min. Amoxycillin 500mg 3*daily and prednisolone 25mg daily* days was added along with ventolin and preventer.
    Today morning patient presented in desaturating condition with respiratory rate 25/min, pulse rate 112/min, temperature – 37.7, B.P. – 100/65 with widespread wheezing and bibasal crepitations. increase work of breathing is visible in form of use of accessory muscles of respiration. patient was given ventolin nebules 5mg but there is no improvement after 15 minutes.
    Patient is non smoker with no history of allergies. Past history of hypertension, cholecytectomy, ankle fracture and depression are present. For this she is taking ramipril 2.5mg daily, paroxetine 20mg daily, fluticasone 250 2puffs daily, ventolin 2puffs if required.
    Hence i am referring the patient to you for expert care and management of ?pneumonia exacerbating acute asthma.
    Sincerely
    Doctor

  103. Admitting Officer
    Emergency Department
    Newton Hospital

    13th September 2014

    Dear Dr.,
    Re: Ms Sally McConville, aged 38

    I’m writing to refer Ms McConville for acute management and investigation of respiratory distress for possible pneumonia.

    Ms McConville doesn’t have any allergies and she suffers from asthma, hypertension, and depression. She is on treatment with ramipril 2,5mg daily; paroxetine 20mg daily and salbutamol 2 puff if required. Also, she had a cholecystectomy and ankle fracture. Mc McConville is a non – smoker.

    On 10th September, Ms McConville was diagnosed with viral upper respiratory tract infection and infective exacerbation of asthma without shortness of breath. Ms Conville was on treatment with Ventolin 2 puff every 4 hours, however, on 12th September, the shortness of breath and wheeze increased. Ms McConville took amoxicillin 500mg and prednisolone 25mg 3 times per day and continue 4 hourly Ventolin.

    Today, Ms McConville presents short of breath at rest; accessory muscle use and increase of the work of breathing. She has widespread wheeze and bibasal crepitations. In terms of vital signs, the respiratory rate is 25, pulse is 112, blood pressure 100/65 and temperature is 37.7. She took Ventolin Nebules 5mg without improvement.

    We kindly request her assessment. If you have any queries, don’t hesitate to contact me.
    Yours sincerely,
    Doctor.

  104. September. 13,2014

    Admitting Officer
    Emergency Department
    Newtown Hospital
    Newtown

    Dear Doctor,

    Re: Sally McConville, aged 38 years

    I am writing to refer Ms. McConville with symptoms of respiratory distress to your care for urgent management.
    Ms. McConville has a history of asthma, hypertension and depression and have been taking Ramipril, Paroxetine fluticasone and Ventolin inhaler as needed.
    Two days ago , she presented with symptoms of viral upper respiratory infection along with infective exacerbation of asthma. He was advised to increase Ventolin inhaler 2pffs 4 hourly along with continuing her preventer inhaler.
    On the 12th, she presented with worsening of her symptoms. Amoxicillin and prednisolone were prescribed three times daily.
    Today she presented with shortness of breath despite taking antibiotics and prednisolone. She has been given Ventolin nebulization with no improvement in her symptoms.
    I would like you to kindly manage Ms. McConville in the emergency department and order further investigations if required.
    Please feel free to contact me if you have further questions.
    Yours Sincerely

    Doctor X

  105. Admitting Officer
    Emergency Department
    Newton Hospital
    13/9/2014

    Dear Officer,
    Re: Sally Mcconville, 38 years old

    I am writing to refer Ms Mcconville, who requested an urgent investigation and management cause of pneumonia, and her condition was worsening despite treatment.

    Her medical history includes asthma, hypertension, and depression and she is taking Ramipril 2.5 mg daily, Paroxetine 20 mg daily and Fluticasone 250 mg two puffs daily, Ventolin 2 puffs when she needs.

    On 10/09/2014, she presented with a runny nose, cough, slight fever, and wheezy, and her asthma was well controlled under medication. On examination, her throat was red and widespread wheezing was shown. My previous diagnosis was viral upper tract infection and using Ventolin 2 puffs every 4 hours was recommended.

    On 12/09/2014, she complained of shortness of breath and wheezing for over twenty-four hours. Amoxicillin 500mg three times daily and prednisolone 25 mg three times daily were prescribed.
    On today’s visit, his breath was worse despite antibiotics and prednisolone treatment. Ventolin nebules 5mg was administered but on the review, there was no improvement and she was under respiratory stress.

    In the view of above , she has requested urgent management and assessment .If you have any queries please contact me.

    Doctor P.

  106. 14/08/2022
    Admitting officer
    Emergency Department
    Newton Hospital
    Dear Sir/Madam
    RE:Ms Sally Mcconville,aged 38 years
    Thank you for accepting Ms Mcconville into your care whom I am reffering for acute care and further investigations.She is a known case of asthma has been diagnosed with pneumonia following persitent and recurring episode of shortness of breath over the past 24 hours.In addition to her symptoms she was febrile and dyspneaic on minimal exertion ,with productive cough and yellowish sputum.

    On examination her vital signs are as follows:BP 100/65,Pulse 112,Temp 38″c,she looked unwell with obvious respiratory distress despite administration of antibiotics and prednesolone.Prior to this refferal she has had consequative visits on the 10th and 12th september 2014 which i have managed and disposed home on medication.

    sputm

  107. September 13th, 2014
    Admitting Officer
    Emergency Department
    Newtown Hospital

    Re: Ms. Sally McConville

    Thank you for taking the referral of Ms. McConville for further investigation and treatment of her acute asthma exacerbation and possible pneumonia.

    Ms. McConville is a 38 years old non-smoker administrator with no known allergies who is diagnosed and treated for asthma, hypertension and depression.

    On 10.09.14 she was diagnosed with viral upper respiratory tract infection and infective asthma exacerbation for which she was advised to increase the salbutamol doses (e/4 hs). Two days later she presented with SOB and widespread wheezing, therefore, treated with antibiotics, corticoids and continue with the inhaler as prescribed.
    Today she presented with a worsening in her symptoms with fever, a respiratory rate of 25, increase SOB, noticeable accessory muscle use, widespread wheeze and bibasal crepitation. The patient shows no improvement despite salbutamol treatment for which I would be most grateful if you can assist her.

    Please do not hesitate to contact me if you need further information.

    Yours Faithfully
    Dr. NN

  108. Admitting Office
    Emergency Department
    Newtown Hospital

    13/09/2014

    Dear Admitting Officer,
    Re: Ms. Sally McConville, aged 38

    I am writing you to urgently refer Ms. McConville regarding aggravating of her symptoms of asthma during the last few days.

    Symptoms started on 10/09/2014 with a productive cough, runny nose and slight fever. On examination, she was mildly wheezy without shortness of breath. During the next two days, her condition starts to deteriorate with developing shortness of breath, widespread wheezing and raising of her body temperature. At this point I suspect as a possible cause, infective exacerbation of asthma. She has been discharged with advice of taking Amoxicillin 500mg 3 times daily with Prednisolone 25mg daily during the next 3 days. Despite recommended treatment, she came to my office again (13/09/2014) with a complaint of difficulty with breathing and further increased shortness of breath, stated at this occasion about feeling extremely unwell. On the assessment, she had obvious signs of respiratory distress with increased work of breathing, widespread wheezing and developed bibasilar crackles on this occasion. She has a long stand history of asthma until now successfully managed with Fluticasone and Ventolin (if required), hypertension managed with Ramipril and depression for which she is taking Paroxetine.

    I would like to kindly ask you to accept Ms. McConville for the urgent assessment and further management regarding deterioration of her asthma symptoms and possibly developing of pneumonia. Please do not hesitate to contact me if you need any further assistance.

    Your sincerely,
    Dr S. Stojkovic

  109. 13th September 2014

    To
    The Admitting Officer
    The Emergency Depatment
    Newtown Hospital.

    Re: Ms Sally McConville, aged 38

    Dear Sir/Madam,
    I am writing to refer this patient to the emergency department for acute exacerbation of asthma, possibly due to an infectious cause.

    Ms McConville presented two days ago to my clinic with symptoms of an upper respiratory tract infection and wheeze. She was diagnosed with a mild exacerbation of asthma due to viral infection. She was managed with Ventolin puffs and discharged home.

    Yesterday, Ms McConville presented with worsening of her symptoms and was producing yellow sputum. She was prescribed amoxicillin, prednisolone and was told to continue the Ventolin puffs.

    Today, her symptoms have worsened despite the therapy. She feels short of breath at rest and feverish. Examination showed that her pulse rate was 112/minute. Her BP was normal . In her lung examination, widespread wheeze and bibasal crepitations were heard. Ventolin puffs were administered to her. After 15 minutes, she hadn’t shown any improvement in symptoms.

    In view of the situation I have described above, I kindly request you to admit Ms McConville to your emergency deparment and take further measures as required.
    Please be free to contact me regarding further inquires.

    Thank You,
    Yours faithfully,
    Doctor.

  110. Admitting officer
    Emergency department
    Newtown Hospital

    13/9/14

    Dear Doctor,
    Re: Ms. Sally McConville, aged 38 years

    I am writing to refer Ms. Sally who requires urgent assessment and management for respiratory distress.
    Ms. McConville has a history of hypertension and asthma. She is currently on Ramipril, fluticasone, and Ventolin.
    Today, she presented with shortness of breath which could not be subsided by prednisolone and antibiotics. She also had a fever. Nebulization with salbutamol 5m did not improve her symptoms and she was still in respiratory distress 15 minutes later. Examination revealed dyspnea at rest, accessory muscle use, and increased work of breathing. Bibasilar crepts and widespread wheezes were heard in the chest. Her respiratory rate was increased as well.
    Ms. McConville initially visited on 10/9/14, with a 2-day history of runny nose, productive cough, mild fever, and wheezes. She was sent home on 4 hourly Ventolin. However, She returned two days later with shortness of breath in addition to her previous symptoms. Examination showed mildly increased work of breathing and widespread wheeze. Amoxicillin and Ventolin were prescribed to her.
    Please see Ms. McConville for further assessment of her condition.
    If you have any queries, please do not hesitate to contact me.

    Yours faithfully,
    Doctor.

  111. Admitting Officer
    Emergency Department
    Newtown Hospital
    Newtown

    September 13, 2014

    Dear Admitting Officer,
    RE: Sally McConville, aged 38

    I am writing regarding Ms McConville, who has been visiting my clinic due to infection related respiratory distress. Ms McConville is being referred to you for further management and investigation.
    Ms McConville is a nonsmoker with a history of asthma, hypertension and depression. Her medications include ramipril, paroxetine, fluticasone (2x daily), and Ventolin (2x daily if needed). She has no history of allergies.
    10/09/14 Ms McConville presented with a 2-day course of coryza, cough productive of yellow sputum, slight fever and wheeze. She was diagnosed with viral upper respiratory tract infection and infective exacerbation of asthma. Ventolin was prescribed, 2 puffs 4-hourly and review was offered if needed.
    Over the following 3 days, Ms McConville’s symptoms worsened. On 12/09/14 she presented feverish, short of breath and wheezing. Antibiotics were given, however she returned on 13/09/14 with no substantial improvement. Today, she is short of breath at rest and is still feverish.
    I have given her Ventolin nebulizer 5mg. I am concerned this may be a case of pneumonia. Please note Ms McConville is being referred to you for urgent management and investigation. Feel free to contact me with any questions.
    Regards,
    Doctor

  112. Admitting Officer
    Emergency Department
    Newtown Hospital

    8 September 2022

    Dear Admitting Officer,

    Re: Ms. Sally McConville, Age 38

    Ms. McConville is being referred to your care for her acute asthma with possible pneumonia.

    Three days ago, Ms McConville presented with 2 day onset of runny nose, productive cough, wheezing and fevers. The physical examination was remarkable for red throat, nasal congestion and scattered chest wheezing. Given that patient has history of Asthma, I prescribed Ventolin 2 puffs given every 4 hours, added to her current asthmatic regimen of Fluticasone 250mg 2 puffs daily.

    Ms McConville continues to be symptomatic and started having increasing shortness of breath, necessitating administration of Amoxicillin 500mg three times a day and Prednisolone 25mg daily for 3 days. Despite added treatment, she remains in respiratory distress. I am considering to begin her on another medication: Ventolin Nebules (Salbutamol) 5mg.

    Please investigate and provide acute management of Ms McConville non-improving respiratory distress.

    Should you have any questions, please don’t hesitate to contact me.

    Yours Faithfully,

    Doctor

  113. Dr. Jones
    Newton Memory clinic
    400 Rail Rd
    Newton

    1 Aug 2018
    Dear Dr. Jones
    Re: Mrs. Patricia Walshman (DOB: 10/07/1933)

    I am writing to refer Mrs. Walshman for assessment and diagnosis of full memory.

    Mrs. Walshman is a widower and lives alone with her children living within 10 km radius. She has a history of osteoporosis and is taking osteo vit-D 1000 IU, Atorvastatin 20 mg, metoprolol 100 mg b.d and paracetamol 500 mg prn. There is a family history of Alzheimer’s. Her next of kin is her daughter, Christine.

    She has had regular visit previously for regular visit with no concern or issue. However, On Oct 2017, she sustained one fall which led to bruised nose only. On the subsequent visit, community support was suggested along with occupational therapist suggesting various methods to decrease chance of recurrent fall. On her visit on 26 march 2018, BP was mildly elevated 145/85 and Vit D decreased. Considering finding spare scripts during the discussion, Webster’s pack suggested to ensure compliance with medication.

    On today’s visit, both patient and daughter voiced concern regarding poor memory, behavioral changes and decision-making issues. BP 130/70 and the patient is compliant with medication.

    I would appreciate it if you could further assess her memory and address their concern for memory impairment.

    If you have any question, please do not hesitate to contact me

    Sincerely,

    Doctor

  114. The Admitting Officer,
    Emergency Department,
    Newton Hospital.

    Re Ms. Sally Aged 38.
    Date 13/9/14

    Dear Dr.,
    I am writing for urgent referral for management and investigation of Ms. Sally who is known asthmatic and suffering from respiratory distress.
    She has been suffering from sob, fever and feeling unwell for 3 days which become progressively worse today. Today on examination she was in respiratory distress with widespread rhonchi and wheeze. Her pulse was 112bpm and blood pressure was 100/65. She has been nebulized with Ventolin but no improvement. she already given amoxicillin and steroid for 3 days.
    Ms. Sally has hypertension and depression and taking Ramipril and Paroxetine. And she has no allergies.
    Please see her for urgent management and investigation. If you have any query, please don’t hesitate to ask me.

    Thanks.

    Dr.Binish

  115. 17 September 2022

    The Admitting Officer
    Emergency Department
    Newtown Hospital

    Dear Doctor,

    RE: Ms Sally McConville, age 38.

    I am writing to urgently refer Ms McConville, a 38year old administrator who has presented with an acute exacerbation of her asthma symptoms causing her respiratory distress.

    She initially presented 3 days ago with a 2 day history of a slight fever , productive cough and wheeze. On examination, she had scattered wheezes but not increased work of breathing. A diagnosis of a viral URTI was made thereafter treated with Ventolin 2 puffs four hourly and also advised to continue with her preventer inhaler.

    Ms McConville was then seen again 2 days after with escalating symptoms of increased SOB and persistent wheezing over 24 hours. Amoxicillin 500mg tablets three times daily and oral prednisolone 25mg daily for 3 days were instituted in addition to her preventer and reliever inhalers.

    Today her symptoms have continued to evolve in that she has a wide spread wheeze with bibasal crepitations and a slightly low BP ( 100/65mmhg) with no improvement in spite of treatment with a salbutamol nebulizer.

    Her past medical history includes asthma that is well controlled with fluticasone 250mg – 2puffs daily, hypertension and depression for which she takes ramipril 2.5mg daily and paroxetine 20mg daily.

    Given her escalation of symptoms due to probable pneumonia with a failure to respond to the prescribed treatment, she will need ED admission for further assessment and management of her condition.

    In case of any queries, please do not hesitate to contact me.

    Yours Sincerely,

    Doctor.

  116. Admitting Officer
    Emergency Department
    Newtown Hospital,
    Newtown

    13 September, 2014

    RE: Ms. Sally McConville

    Dear Maam or Sir

    I am writing this letter to refer Ms. McConville, a 38 year old administrator with signs of severe pneumonia and would require urgent medical management.

    On September 9, she initially presented with a two day history of runny nose associated with productive cough with yellowish sputum. On physical exam, there was nasal congestion and scattered wheezing upon auscultation but was comfortable at rest. However, 2 days after her condition progressed with increased work of breathing associated with onset of fever. There was generalised wheeze on auscultation with no crepitations. She was given 3 days course of amoxicillin and prednisolone in addition to her ventolin and preventer.

    However, today her condition worsen with signs of respiratory distress. She is noted to be tachypniec and tachycardic. Her BP is currently at 100/65 with bibasal crepitations and generalised wheezing on auscultation. Her medical history includes asthma and hypertension in which she is maintained on fluticasone, salbutamol, ramipril and paroxtine. She has no known allergies.

    In view of this, it would be greatly appreciated if you could admit Ms. McConville and urgently manage her condition.

    Thank you for taking part of Ms. McConville’s care and if you require further information please do not hesitate to contact me.

    Yours sincerely,
    Doctor

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