841 HEATHER ROAD BURLINGTON, NC 27215 336.229.7776 FAX 336.227.4242 www.ur ! "#NC.

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NAME: CHART #: DATE OF BIRTH: DATE: _____, _____ _____ 09/14/1934 11/__/2012

HISTORY OF PRESENT ILLNESS: Mr. Westbrooks is a 68-year-old white male with a history o kid!ey sto!es a!d diabetes. "e also has de#elo$ed ere%tile dys &!%tio! a!d wo&ld like some hel$ with that. 'e(&al health i!#e!tory or me! was 10. "e de!ied la!k $ai! or hemat&ria. "e is #oidi!) with a )ood stream. *+'' s%ore was 4. "e was last see! here o! ,o#ember 29, 2011. PAST MEDICAL HISTORY: Allergies: +atie!t had !o dr&) aller)ies. Current Medic ti!ns: "e does !ot take a!y medi%atio!s. Pre"i!us Surgic l Pr!cedures: *!)&i!al her!iorrha$hy. S!ci l Hist!r#: +atie!t de!ied toba%%o &se. "e %o!s&mes 8-14 al%oholi% be#era)es $er week. F $il# Hist!r#: -emarkable or hy$erte!sio!. ../!der this, &!less s$e%i ied $ositi#e or a %o!ditio!, $lease &se this !ormal00 P st nd Current Medic l C!nditi!ns: 1he $atie!t de!ies history o the ollowi!)2 a%id re l&(, aller)i% rhi!itis, a!(iety, arthritis, asthma, atte!tio! $roblems, bleedi!) disorders, breast %a!%er, ra%t&red bo!es, %olo! or re%tal %a!%er, de$ressio!, diabetes, eati!) disorder, ere%tile dys &!%tio! %c&ec' (!r gender !( ) tient*, )astroi!testi!al disease, heari!) $roblems, heart disease, hy$erte!sio!, hi)h %holesterol, i!som!ia, 3oi!t i!3&ries, kid!ey disease, li#er disease, l&!) %a!%er, l&!) disease, mi)rai!e heada%hes, obesity, osteo$orosis, o#era%ti#e bladder, +arki!so! disease, $rostate %a!%er %c&ec' (!r gender !( ) tient*, sei4&re disorder, e$ile$sy, se(&ally tra!smitted diseases, ski! $roblems, stroke, thyroid disease, a!d #isio! $roblems. Re"ie+ !( S#ste$s: 1he $atie!t de!ied the ollowi!) ..&!less s$e%i ied otherwise002 wei)ht %ha!)e, ati)&e, e#er, %hills, !i)ht sweats, rash, slee$ dist&rba!%e, do&ble #isio!, eye $ai!, loss o #isio!, di i%&lty swallowi!), %hest $ai!, swelli!) o le)s or a!kles, le) $ai!, short!ess o breath, %o&)h, %o&)hi!) &$ blood, !a&sea, #omiti!), diarrhea, %o!sti$atio!, heari!) loss,

stoma%h $ai!, blood i! &ri!e, re5&e!t &ri!ary i! e%tio!s, $ai! &l &ri!atio!s, swolle! )la!ds, re5&e!t !osebleeds, blood i! stool, easy br&isi!), &!wa!ted )rowth o hair, hair loss, di44i!ess, re5&e!t alli!), !&mb!ess i! arms a!d le)s. PHYSICAL E,AM: -it l Signs: Wt 196 lbs, ht 6768, 9+ 148/:8. -emai!i!) $ortio! o $hysi%al e(am will be di%tated o! hos$ital system. PHYSICAL E,AM: -it l Signs: Wt 160 lbs, ht 6748, 9+ 140/84, $&lse 80, tem$ 98.6. M;<= .ener l: HEENT: Nec': Well-!o&rished male i! !o a%&te distress. '%lerae were %lear, +=--<;, =>Ms i!ta%t. ,o $al$able masses or te!der!ess, thyroid )la!d was smooth witho&t $al$able !od&les, !o a&dible %arotid br&its. L#$)& tic: ,o $al$able !e%k or )roi! ade!o$athy. Pul$!n r#: <&!)s were %lear to a&s%&ltatio! with !ormal res$iratory e ort witho&t i!tra%ostal retra%tio!s. C rdi!" scul r: --- with a&dible m&rm&r or )allo$s. ,o a&dible la!k br&its. ,o $eri$heral edema. .I: ;bdome! was so t with !o ?@; te!der!ess. 9ladder a!d kid!eys were !ot $al$able. ,o abdomi!al, i!)&i!al or emoral her!ias. <i#er a!d s$lee! were !ot $al$able or te!der. 'tool s$e%ime! was !ot %olle%ted or i!di%ated. Rect l: +rostate 16 )m smooth a!d !o!te!der $rostate. 'emi!al #esi%les !ot $al$able or swolle!. ,o $al$able re%tal masses. Neur!/Ps#c&i tric: ;lert a!d orie!ted to time, $la%e a!d $erso!. ,o ob#io&s a!(iety, de$ressio! or a)itatio!. A=M;<= .ENERAL: HEENT: Nec': L#$)& tic: Pul$!n r#: C rdi!" scul r: .I: Well-!o&rished emale i! !o a%&te distress. '%lerae were %lear, +=--<;, =>Ms i!ta%t. ,o $al$able masses or te!der!ess, thyroid )la!d was smooth witho&t $al$able !od&les, !o a&dible %arotid br&its. ,o $al$able !e%k or )roi! ade!o$athy. <&!)s were %lear to a&s%&ltatio! with !ormal res$iratory e ort witho&t i!tra%ostal retra%tio!s. --- with a&dible m&rm&r or )allo$s. ,o a&dible la!k br&its. ,o $eri$heral edema. ;bdome! was so t with !o ?@; te!der!ess. 9ladder a!d kid!eys were !ot $al$able. ,o abdomi!al, i!)&i!al or emoral her!ias. <i#er a!d s$lee! were !ot $al$able or te!der. 'tool s$e%ime! was !ot %olle%ted or i!di%ated.

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,ormal e(ter!al emale )e!italia. ,o #a)i!al dis%har)e. ,e)ati#e Marshall test. ,o &rethral hy$ermobility. ,o %ysto%ele or #a)i!al $rola$se. ?er#i( a!d &ter&s were smooth a!d !o!te!der witho&t $al$able ad!e(al masses. Rect l: ,o $al$able re%tal masses. Neur!/Ps#c&i tric: ;lert a!d orie!ted to time, $la%e a!d $erso!. ,o ob#io&s a!(iety. .ener lB .I: Well-!o&rished ; ri%a!-;meri%a! male i! !o distress. ;bdome! was so t with !o ?@; te!der!ess. 9ladder a!d kid!eys were !ot $al$able. ,o abdomi!al, i!)&i!al or emoral her!ias. <i#er a!d s$lee! were !ot $al$able or te!der. 'tool s$e%ime! was !ot %olle%ted or i!di%ated. 30-)m, smooth, !o!te!der $rostate, otherwise !ormal e(am.

Rect l:

LABORATORY DATA: /ri!alysis C yellow, %lear, $" 6, s&)ar 0, alb&mi! tra%e, mi%ros%o$i% !e)ati#e. LABORATORY DATA: !e)ati#e. /; C yellow, %lear, $" 6.6, s&)ar 0, alb&mi! 0, mi%ros%o$i%

D/9 re#ealed a 6 mm sto!e a!d a 2 mm sto!e i! the re)io! o lower $ole. "e had de)e!erati#e %ha!)es o the l&mbar s$i!e. IMPRESSION: 1. <e t !e$hrolithiasis. 2. =re%tile dys &!%tio!. 3. Eiabetes. PLAN: 1. -e$eat D/9 i! o!e year. 2 >btai! testostero!e a!d +'; today. *!str&%ted to %all or res&lts !e(t week.

__________________________ Mi%hael -. Wol , M.E., A;?' M-W/abdB_____