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Chief Complaint Of Diabetes Mellitus

Diabetes Mellitus

Diabetes Mellitus

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. Diabetes mellitus is a disease caused by deficiency or diminished effectiveness of endogenous insulin. It is characterised by hyperglycaemia, deranged metabolism and sequelae predominantly affecting the vasculature. The main types of diabetes mellitus are: Type 1 diabetes mellitus: results from the body's failure to produce sufficient insulin. Type 2 diabetes mellitus: results from resistance to the insulin, often initially with normal or increased levels of circulating insulin. Gestational diabetes: pregnant women who have never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women. It may precede development of type 2 (or rarely type 1) diabetes. Maturity-onset diabetes of the young (MODY) includes several forms of diabetes with monogenetic defects of beta-cell function (impaired insulin secretion), usually manifesting as mild hyperglycaemia at a young age and usually inherited in an autosomal-dominant manner.[1] Secondary diabetes: accounts for only 1-2% of patients with diabetes mellitus. Causes include: Pancreatic disease: cystic fibrosis, chronic pancreatitis, pancreatectomy, carcinoma of the pancreas. Endocrine: Cushing's syndrome, acromegaly, thyrotoxicosis, phaeochromocytoma, glucagonoma. Drug-induced: thiazide diuretics, corticosteroids, atypical antipsychotics, antiretroviral protease inhibitors. Congenital lipodystrophy. Aca Continue reading >>

Clinical Presentation And Management Of Diabetes Mellitus In Pregnancy

Clinical Presentation And Management Of Diabetes Mellitus In Pregnancy

Clinical presentation and management of diabetes mellitus in pregnancy 2Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait Correspondence: Michael F Diejomaoh, Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait, Tel +965 253 1 9601, Fax +965 253 3 8906, Email [email protected] Author information Copyright and License information Disclaimer Copyright 2014 Al-Azemi et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution Non Commercial (unported, v3.0) License The full terms of the License are available at . Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregnancy. One hundred seventy-one patients with diabetes mellitus admitted between September 1, 2006, and June 30, 2008, to the labor room at Maternity Hospital in Kuwait for induction of labor made up the study population; while an equivalent number of patients without medical complications who also were admitted for induction of labor made up the control group. The patients were assessed at admission, and their medical data were extracted. The study and control patients were monitored through labor/puerperium, and the outcome was documented. Gestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 812 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patient Continue reading >>

Gestational Diabetes: Symptoms, Diagnosis & Complications

Gestational Diabetes: Symptoms, Diagnosis & Complications

MORE Gestational diabetes is a type of diabetes that develops, or is first diagnosed, during pregnancy. The condition, like other forms of diabetes, involves high blood sugar levels. Often times, gestational diabetes is a temporary disorder that occurs around the second trimester of pregnancy, and disappears after a woman gives birth. "Even if a woman had required quite a bit of therapy and treatment to keep her blood sugars under control when she was pregnant … usually the day after delivery, [her] sugars go back down to normal," said Dr. Christopher Glantz, a professor of obstetrics and gynecology at the University of Rochester Medical Center. But women who've had gestational diabetes should be monitored closely after birth, because they are more likely to develop diabetes later in life, according to the National Institutes of Health (NIH). A 2014 study from the Centers for Disease Control and Prevention found that between 4 and 9 percent of pregnant women in the United States develop gestational diabetes. Gestational diabetes occurs more frequently among certain ethic groups, including African Americans, Hispanics, American Indians, Asians, and Pacific Islanders according to the March of Dimes. Symptoms Women with gestational diabetes usually have no symptoms or mild, non-life-threatening symptoms, according to the NIH. These symptoms are mostly related to abnormal blood sugar levels, and can include fatigue, excessive thirst and increased urination. Causes During pregnancy, changes happen in the mother's body to make sugar more available to the fetus, Glantz said. One of these changes is that the placenta produces hormones that interfere with the action of insulin, a hormone that helps sugar (or glucose) get from the bloodstream into cells. This means that sugar i Continue reading >>

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3] Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatri Continue reading >>

Diabetic Patient Amputation: Amputee Case Study

Diabetic Patient Amputation: Amputee Case Study

Diabetic patient amputation: Amputee Case Study Lower limb disease especially linked to diabetes causes a significant number of amputations yearly. Thorough knowledge of risk factors like ulceration, infection and neuropathy can make the management of the diabetic foot much easier. A large number of amputations can be prevented through early detection by the patient and proper management by a multidisciplinary team. The functional impairments and disability of amputees can be described and assessed through a globally accepted framework provided by the International Classification of Functioning. Strong focus should be placed on psychological Type 2 Diabetes, diabetic ulcers, amputation, transtibial, prosthesis, rehabilitation Jumbo is a 56 year old self supportive male that has been referred to Physiotherapy for prosthetic prescription and rehabilitation. He has his own construction company where both his sons are involved. A Trans Tibial (TT) amputation was done on his right leg to save his life after serious infection and gangrene. Jumbo initially suffered from peripheral neuropathy associated with uncontrolled diabetes. With the decreased sensation he unknowingly stepped up on hot coals that burned through the sole of his shoe. Poor blood supply in his leg and foot hindered wound healing, the blisters got infected and turned into foot ulcers and later severe gangrene. Numerous courses of antibiotics and specialized wound care could not stop the deterioration of the tissue. Jumbo had a very inactive lifestyle and gained excessive weight. Multiple medical conditions that co-exist include: Type 2 Diabetes, hypertension, obesity, peripheral artery disease and persistent peripheral oedema. Currently his diabetes and hypertension is under control with medication. His chief Continue reading >>

Icd-10 Scenarios For Internal Medicine

Icd-10 Scenarios For Internal Medicine

The clinical concepts for internal medicine guide includes common ICD-10 codes, clinical documentation tips and clinical scenarios. ICD-10 Clinical Scenarios for Internal Medicine Scenario 1: Follow-Up: Kidney Stone Scenario 2: Epigastric Pain Scenario 3: Diabetic Neuropathy Scenario 4: Poisoning Scenario: COPD with Acute Pneumonia Example Scenario: Cervical Disc Disease Scenario: Abdominal Pain Scenario: Diabetes Scenario: ER Follow Up Quality clinical documentation is essential for communicating the intent of an encounter, confirming medical necessity, and providing detail to support ICD-10 code selection. In support of this objective, we have provided outpatient focused scenarios to illustrate specific ICD-10 documentation and coding nuances related to your specialty.The following scenarios were natively coded in ICD-10-CM and ICD-9-CM. As patient history and circumstances will vary, these brief scenarios are illustrative in nature and should not be strictly interpreted or used as documentation and coding guidelines. Each scenario is selectively coded to highlight specific topics; therefore, only a subset of the relevant codes are presented. The following scenarios were natively coded in ICD-10-CM and ICD-9-CM. As patient history and circumstances will vary, these brief scenarios are illustrative in nature and should not be strictly interpreted or used as documentation and coding guidelines. Each scenario is selectively coded to highlight specific topics; therefore, only a subset of the relevant codes are presented. Internal Medicine Clinical Scenarios: Scenario 1: Follow-Up: Kidney Stone Scenario Details Chief Complaint Follow-up from encounter 2 days ago, review results of tests1. 87 year old female with right lower back / flank pain (described as dull, achy and do Continue reading >>

Symptoms

Symptoms

Print Overview Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes are: Increased thirst Frequent urination Extreme hunger Unexplained weight loss Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin) Fatigue Irritability Blurred vision Slow-healing sores Frequent infections, such as gums or skin infections and vaginal infections Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40. When to see a doctor If you suspect you or your child may have diabetes. If you notice any poss Continue reading >>

Clinical Presentation Of Diabetes Mellitus

Clinical Presentation Of Diabetes Mellitus

The body appears unable to sense glucose levels directly, but people with diabetes learn to appreciate when their blood glucose is outside the normal range by indirect cues, such as thirst when the glucose is too high and sweating and palpitations when it is too low. Diabetes may present acutely, with the three classic symptoms of thirst, polyuria and weight loss; even so, clinical recognition may be delayed until the patient is seriously ill. Many forms of diabetes, including type 2, present less dramatically. Increased thirst and polyuria may not be noticed because they develop slowly, and weight loss may be welcomed by those who are trying to diet. People at this stage of diabetes may call on their doctor with a range of non-specific symptoms such as tiredness and loss of energy; alternatively they may come to notice because of acute complications of diabetes, including hyperglycaemia emergencies and infections, or longer term complications including retinopathy, neuropathy, cataracts, cardiovascular or cerebrovascular disease. People with type 2 diabetes may have had the condition for several years before they come to clinical notice, and many countries now have screening policies to allow earlier detection and treatment. Background Early recognition of diabetes is important, not least because delayed recognition may result in hospital admission with a metabolic emergency. Delayed recognition of type 2 diabetes may mean that avoidable long term complications of diabetessuch as retinopathyor neuropathyare already present at diagnosis. The classic symptoms of diabetes form the triad of thirst, polyuria and weight loss: Thirst arises as a consequence of dehydration resulting from loss of fluid, salt and other electrolytes in the urine. The acute thirst of type 1 diabet Continue reading >>

Diagnosing Type 2 Diabetes Before Patients Complain Of Diabetic Symptomsclinical Opportunistic Screening In A Single General Practice

Diagnosing Type 2 Diabetes Before Patients Complain Of Diabetic Symptomsclinical Opportunistic Screening In A Single General Practice

Diagnosing Type 2 diabetes before patients complain of diabetic symptomsclinical opportunistic screening in a single general practice St Leonard's Research General Practice, Athelstan Road, Exeter EX1 1SB, UK Correspondence to Philip Evans, St Leonard's Research General Practice, Athelstan Road, Exeter EX1 1SB, UK; Email: [email protected] Evans P, Langley P and Pereira Gray D. Diagnosing Type 2 diabetes before patients complain of diabetic symptomsclinical opportunistic screening in a single general practice. Family Practice 2008; 25: 376381. Received 2007 Oct 23; Revised 2008 Jul 18; Accepted 2008 Jul 29. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. In the UK, patients normally see their general practitioner first and 86% of the health needs of the population are managed in general practice, with 14% being referred to specialist/hospital care. Early diagnosis is the privilege of general practice since general practitioners make most medical diagnoses in the NHS. Their historic aim has been to diagnose as early as possible and if possible before patients are aware of symptoms. Over time, diagnoses are being made earlier in the trajectory of chronic diseases and pre-symptomatic diagnoses through tests like cervical screening. Earlier diagnosis benefits patients and allows earlier treatment. In diabetes, the presence of lower HbA1c levels correlates with fewer complications. Methodologically, single practice research means smaller populations but greater ability to track patients and ask clinicians about Continue reading >>

Diabetes Mellitus Signs And Symptoms

Diabetes Mellitus Signs And Symptoms

There are three main types of diabetes: Type 1 Diabetes: About 5 to 10 percent of those with diabetes have type 1 diabetes. It's an autoimmune disease, meaning the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin, and must take insulin everyday. Although the condition can appear at any age, typically it's diagnosed in children and young adults, which is why it was previously called juvenile diabetes. Type 2 Diabetes: Accounting for 90 to 95 percent of those with diabetes, type 2 is the most common form. Usually, it's diagnosed in adults over age 40 and 80 percent of those with type 2 diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed at younger ages, including in children. Initially in type 2 diabetes, insulin is produced, but the insulin doesn't function properly, leading to a condition called insulin resistance. Eventually, most people with type 2 diabetes suffer from decreased insulin production. Gestational Diabetes: Gestational diabetes develops during pregnancy. It occurs more often in African Americans, Native Americans, Latinos and people with a family history of diabetes. Typically, it disappears after delivery, although the condition is associated with an increased risk of developing diabetes later in life. If you think that you have diabetes, visit your doctor immediately for a definite diagnosis. Common symptoms include the following: Frequent urination Excessive thirst Unexplained weight loss Extreme hunger Sudden vision changes Tingling or numbness in the hands or feet Feeling very tired much of the time Very dry skin Sores that are slow to heal More infections than usual Some people may experience o Continue reading >>

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

INTRODUCTION The term diabetes mellitus describes several diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. Every few years, the diabetes community reevaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice. The American Diabetes Association (ADA) issued diagnostic criteria for diabetes mellitus in 1997, with follow-up in 2003 and 2010 [1-3]. The diagnosis is based on one of four abnormalities: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose tolerance test (OGTT) (table 1). Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are referred to as having increased risk for diabetes or prediabetes. (See 'Diagnostic criteria' below.) Screening for and prevention of diabetes is reviewed elsewhere. The etiologic classification of diabetes mellitus is also discussed separately. (See "Screening for type 2 diabetes mellitus" and "Prevention of type 2 diabetes mellitus" and "Prevention of type 1 diabetes mellitus" and "Classification of diabetes mellitus and genetic diabetic syndromes".) CLINICAL PRESENTATION Type 2 diabetes is by far the most common type of diabetes in adults (>90 percent) and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. The majority of patients are asymptomatic, and hyperglycemia is noted on routine laboratory evaluation, prompting further testing. The frequency of symptomatic diabetes has been decreasing in parallel wi Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

diabetes mel·li·tus (mə-lī′təs, mĕl′ĭ-) [New Latin diabētēs mellītus, literally, honey-sweet diabetes (so called because excessive glucose is excreted in the urine and the resulting sweet taste of the urine was used in diagnosis) : Medieval Latin diabētēs, diabetes; see diabetes + Latin mellītus, honey-sweet (Latin mel, mell-, honey; see melit- in Indo-European roots + -ītus, adjectival suffix).] American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2016 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved. diabe′tes mel′li•tus (ˈmɛl ɪ təs) n. either of two chronic forms of diabetes in which insulin does not effectively transport glucose from the bloodstream: a rapidly developing form, affecting children and young adults, in which the body does not produce enough insulin and insulin must therefore be injected (juvenile-onset diabetes) or a slowly developing form in which the body's tissues become unable to use insulin effectively (adult-onset diabetes). [< New Latin: literally, sweet diabetes] diabetes mellitus A condition characterized by frequent thirst and urination, caused by excess sugar in the blood. Results from a lack of insulin. Noun 1. diabetes mellitus - diabetes caused by a relative or absolute deficiency of insulin and characterized by polyuria; "when doctors say `diabetes' they usually mean `diabetes mellitus'"DMdiabetes - a polygenic disease characterized by abnormally high glucose levels in the blood; any of several metabolic disorders marked by excessive urination and persistent thirstautoimmune diabetes, growth-onset diabetes, IDDM, insulin-dependent diabetes mellitus, juvenile diabetes, juvenile-onset diabetes, ketoacido Continue reading >>

Type 2 Diabetes Mellitusclinical Presentation

Type 2 Diabetes Mellitusclinical Presentation

Type 2 Diabetes MellitusClinical Presentation Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... The diagnosis of diabetes mellitus is readily entertained when a patient presents with classic symptoms (ie, polyuria, polydipsia, polyphagia, weight loss). Other symptoms that may suggest hyperglycemia include blurred vision, lower extremity paresthesias, or yeast infections, particularly balanitis in men. However, many patients with type 2 diabetes are asymptomatic, and their disease remains undiagnosed for many years. In older studies, the typical patient with type 2 diabetes had diabetes for at least 4-7 years at the time of diagnosis. [ 98 ] Among patients with type 2 diabetes in the United Kingdom Prospective Diabetes Study, 25% had retinopathy; 9%, neuropathy; and 8%, nephropathy at the time of diagnosis. (For more information, see Diabetic Neuropathy .) In patients with known type 2 diabetes, inquire about the duration of the patient's diabetes and about the care the patient is currently receiving for the disease. The duration of diabetes is significant because the chronic complications of diabetes are related to the length of time the patient has had the disease. A focused diabetes history should also include the following questions: Is the patient's diabetes generally well controlled (with near-normal blood glucose levels) - Patients with poorly controlled blood glucose levels heal more slowly and are at increased risk for infection and other complications Does the patient have severe hypoglycemic reactions - If the patient has episodes of severe hypoglycemia and therefore is at risk of losing consciousness, this possibility must be addressed, especially if the patient drives or has significant underlying neuropathy or cardiovascul Continue reading >>

Diabetes | Symptom To Diagnosis: An Evidence-based Guide, 3e | Accessmedicine | Mcgraw-hill Medical

Diabetes | Symptom To Diagnosis: An Evidence-based Guide, 3e | Accessmedicine | Mcgraw-hill Medical

The differential diagnosis of diabetes mellitus (DM) is actually a classification of the different causes of diabetes: Of the persons with DM in Canada, the United States, and Europe, 510% have type 1. Caused by cellular-mediated autoimmune destruction of the pancreatic beta cells in genetically susceptible individuals, triggered by an undefined environmental agent Some combination of antibodies against islet cells, insulin, glutamic acid decarboxylase (GAD65), or tyrosine phosphatases IA-2 and IA-2beta are found in 8590% of patients. Risk is 0.4% in patients without family history, 56% in siblings and children, and 30% in monozygotic twins. Patients are also prone to autoimmune thyroid disease, Addison disease, vitiligo, celiac sprue, autoimmune hepatitis, myasthenia gravis, and pernicious anemia. Occasionally occurs without a defined HLA association or autoimmunity in patients of African or Asian ancestry Patients are at high risk for diabetic ketoacidosis (DKA). Type 1 DM generally occurs in children, although approximately 7.510% of adults assumed to have type 2 DM actually have type 1, as defined by the presence of circulating antibodies. Type 2 DM is becoming more prevalent in teenagers and young adults, presumably related to the increased prevalence of obesity. In most patients, the distinction between type 1 and type 2 DM is clear. Thus, the primary tasks of the clinician are to determine who should be tested for diabetes, who has diabetes, which complications to monitor, and how to treat the patient. Mrs. D has worried about having diabetes since her father died of complications from the disease. Over the last couple of weeks, she has been urinating more often and notes larger volumes than usual. She is aware that excess urination can be a symptom of diabetes, Continue reading >>

Endocrinology-diabetes Mellitus - Soap Note - 1(medical Transcription Sample Report)

Endocrinology-diabetes Mellitus - Soap Note - 1(medical Transcription Sample Report)

Sample Type / Medical Specialty: Endocrinology Sample Name: Diabetes Mellitus - SOAP Note - 1 Description: Followup diabetes mellitus, type 1. CHIEF COMPLAINT: Followup diabetes mellitus, type 1. SUBJECTIVE: Patient is a 34-year-old male with significant diabetic neuropathy. He has been off on insurance for over a year. Has been using NPH and Regular insulin to maintain his blood sugars. States that he is deathly afraid of having a low blood sugar due to motor vehicle accident he was in several years ago. Reports that his blood sugar dropped too low which caused the accident. Since this point in time, he has been unwilling to let his blood sugars fall within a normal range, for fear of hypoglycemia. Also reports that he regulates his blood sugars with how he feels, rarely checking his blood sugar with a glucometer. Reports that he has been worked up extensively at hospital and was seeing an Endocrinologist at one time. Reports that he had some indications of kidney damage when first diagnosed. His urine microalbumin today is 100. His last hemoglobin A1C drawn at the end of December is 11.9. Reports that at one point, he was on Lantus which worked well and he did not worry about his blood sugars dropping too low. While using Lantus, he was able to get his hemoglobin A1C down to 7. His last CMP shows an elevated alkaline phosphatase level of 168. He denies alcohol or drug use and is a non smoker. Reports he quit drinking 3 years ago. I have discussed with patient that it would be appropriate to do an SGGT and hepatic panel today. Patient also has a history of gastroparesis and impotence. Patient requests Nexium and Viagra, neither of which are covered under the Health Plan. Patient reports that he was in a scooter accident one week ago, fell off his scooter, hit his head Continue reading >>

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