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Emergency Department female age 44 Time Seen: 19:52; initial patient contact. Arrived- By private vehicle. Historian- patient. HISTORY OF PRESENT ILLNESS Chief Complaint: DIZZINESS. This started 2 weeks and is still present. Described as feeling light-headed (intermittent). Described as feeling mildly weak all over. Severity described as mild at its maximum. When seen in the E.D., severity described as mild. Modifying factors- relieved by nothing. Not worsened by anything. She has had nausea (intermittent). (Pt reports feeling depressed. States she hasn’t felt like she has gotten the attention she needs from VMH regarding her mental condition. Was concerned that she may need to switch meds. Thought she would try taking 30 to 40 mg of Celexa/day rather than 20. States she still feels some depression and anhedonia. Describes this as an ongoing condition. States she feels weak in general. No HI/SI. Denies hearing voices. Eating and drinking ok. Hasn’t done anything to harm self purposefully.). Similar symptoms previously: None. Recent medical care: Not recently seen/assessed.
SCIENCE
HEALTH SCIENCE
NURSING

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