Scribe BC - Allergy and Immunology Consult

Scribe BC - Allergy and Immunology Consult Dear Dr. [referring physician last name] (Only include if explicitly mentioned in transcript or context, else omit section entirely), Thank you for referring this pleasant [age] (Include exact age if mentioned, if under 3 years old write in months-old instead of years-old, otherwise omit) [sex] (Use patient's stated gender, otherwise omit) for allergy/immunology assessment. [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") was seen [in person/via telehealth] (Only include if explicitly mentioned in transcript or context, else omit section entirely). (Write in a phrase.) **History of Presenting Illness:** (For each problem, provide a very detailed narrative history including onset, duration, character, and associated symptoms, past investigations, and previous physicians seen or treatments tried. Include details, quotes, and examples. No new diagnosis should be made in this section, and it should not repeat information provided in the Impression and Plan section.) Rhinitis: [describe rhinitis symptoms including time since onset of symptoms, perennial or seasonal pattern, triggers reported by the patient, medications tried and their degree of benefit if relevant, prior otolaryngologist findings on endoscopy if any. Do not include name of specific diagnoses unless explicitly stated, such as "allergic rhinitis"] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) Asthma: [include the time of diagnosis, asthma symptoms such as dyspnea, chest tightness, wheezing and coughing, most recent pulmonary function test or spirometry and its results if available, presence of nocturnal symptoms or functional limitations, number of exacerbations in the past year, whether emergency room visit was needed, whether oral steroids was needed for asthma exacerbation, current medications available for asthma, frequency of their use, and whether they are followed by a respirologist, if relevant] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) Adverse Food Reactions: (Peanut, almond, hazelnut, cashew/pistachio, walnut/pecan are separate families of foods and should not be combined.) - [Specific food] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Age of patient at time of reaction (age can be in months if provided)] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Size of ingested serving, and specific food ingested] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Symptoms after ingestion, including symptom timing and duration] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Whether patient proceeded to hospital, and any additional symptoms during transport] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Symptoms upon arrival at the Emergency Department (ED)] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Specific medicine(s) given, who it was given by, location where it was administered (home, hospital)] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Symptoms that improved or resolved, including timing of improvement or resolve] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Whether symptoms have reoccurred] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Whether any specific testing was completed previously, including specific test results] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Any accidental or subsequent same food exposures since original; include the form of exposure and size of exposure. The specific allergenic food may be included as an ingredient in another food (e.g., egg in cookie dough). Include symptoms or lack of symptoms which may be a contraindication to the presence of continued allergy to this food or ingredient] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Any additional treatments prescribed previously (e.g., food ladder)] (Only include if explicitly mentioned in transcript or context, else omit section entirely) - [Whether patient has an epinephrine auto-injector, include brand, type, and whether they have training devices available] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Conclude the problem by listing the common allergenic foods that have been tolerated and ones that have not yet been tried. (Common allergenic foods include egg, cow's dairy, wheat, soy, sesame, peanut, almond, hazelnut, cashew or pistachio, walnut or pecan, fish, shellfish.)] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) Eczema or Atopic Dermatitis: [include time of diagnosis, current distribution of affected areas on the body, frequency of flares, moisturizer name and frequency of application, medications tried and their degree of benefit if relevant, current medication plan, prior skin infections, prior dermatologist evaluations] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) Rash or Urticaria: [detailed rash history including time of first onset of the rash, frequency of episodes since initial presentation of the rash, description of the rash including visual features and distribution on the body, how long each spot lasts for, residual findings on the skin after the rash resolves, associated symptoms such as angioedema, medications used with dose if specified and whether there is improvement, prior dermatologist evaluations and whether a biopsy has been done] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) Drug Allergy: [describe the specific drug used, the time of the reaction (in year if available, otherwise the patient's age, or "in childhood" if no further details), the route of administration, indication, number of doses taken before reaction, previously tolerated number of courses, the time duration between last taken dose and onset of symptoms, the symptoms, the duration of symptoms, treatment needed, whether patient proceeded to hospital and any additional symptoms during transport, whether there were features of "Severe Adverse Cutaneous Reactions (SCARs)", whether the specific or related antibiotics have been subsequently tolerated, whether there are any upcoming or ongoing indications for antibiotics, whether any specific testing was completed previously including specific test results] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) Other Problems: [For each problem, provide a very detailed narrative history including onset, duration, character, and associated symptoms, past investigations, and previous physicians seen or treatments tried. Include details, quotes, and examples. No new diagnosis should be made in this section, and it should not repeat information provided in the Impression and Plan section.] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) (Output as a list of each problem with a detailed history in sentence format, and with a new line separating each problem: 1. [Problem 1]: [detailed history] (Only include if explicitly mentioned in transcript or context, else omit section entirely) 2. [Problem 2]: [detailed history] (Only include if explicitly mentioned in transcript or context, else omit section entirely) If the problem is Food Allergy, separate each type of food further in a lettered sub-list under the Food Allergy numbered list item: 1. Food Allergy: a) [Specific food]: [detailed history] (Only include if explicitly mentioned in transcript or context, else omit section entirely) If there are other drugs to which the patient is allergic, separate each type of drug further in a lettered sub-list under the Drug Allergy numbered list item: 1. Drug Allergy: a) [Specific drug]: [detailed history] (Only include if explicitly mentioned in transcript or context, else omit section entirely)) (Write in paragraphs of full sentences.) **Past Medical History**: [documented past medical history, including surgeries and significant conditions] (Only include if explicitly mentioned in transcript or context, else omit section entirely. If nothing mentioned write "Otherwise healthy". Write as a comma-separated list.) **Current Medications:** [list of current medications, including dosage and frequency if available] (Only include if explicitly mentioned in transcript or context, else omit section entirely. If no medications write "No current medications". Write as a single line.) **Stinging Insect Reactions:** [details of any reactions to stings of honey bee, wasp, hornets, including any symptoms, timing between events, treatment required] (Only include if explicitly mentioned in transcript or context, else omit section entirely. If nothing explicitly mentioned, state "None reported". Write in paragraphs of full sentences.) **Adverse Drug Reactions:** [details of any adverse drug reactions, including substances and reactions, or statement of absence] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Family History**: [summary of pertinent family medical history, or statement of noncontributory] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Social History**: [details of relevant environmental factors, such as pets or exposures, tobacco, cannabis or alcohol consumption, occupation, occupational exposures, and extended medical insurance status] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Physical Examination:** **Telehealth note**: Deferred with telehealth. (Only include if the nature of the encouter is via telehealth, else omit this line.) **Head and Neck**: [findings of head and neck examination] (Only include if explicitly mentioned in transcript or context, else omit section entirely. If not explicitly mentioned, state "oropharynx was clear". Write as a single line.) **Chest**: [findings of chest examination] (Only include if explicitly mentioned in transcript or context, else omit section entirely. If not explicitly mentioned, state "no wheezing". Write as a single line.) **Skin**: [findings of skin examination] (Only include if explicitly mentioned in transcript or context, else omit section entirely. If not explicitly mentioned, state "no rash". Write as a single line.) **Skin Testing:** **Inhalants**: **Positive reaction to**: [dust mite/cat/dog/tree pollen/grass pollen/weed pollen/mold] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Include wheal size in mm if stated. Write as a comma-separated list.) **Negative reaction to**: [dust mite/cat/dog/tree pollen/grass pollen/weed pollen/mold] (Only include if explicitly mentioned in transcript or context, else omit section entirely. List all by default if not specified. Write as a comma-separated list.) **Foods**: **Positive reaction to**: [list positive food allergen test results] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Include wheal size in mm if stated. Write as a comma-separated list.) **Negative reaction to**: [list negative food allergen test results] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a comma-separated list.) **Histamine control**: [results of histamine control] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Dermatographism**: Skin testing was complicated by dermatographism. (Only include if explicitly mentioned in transcript or context, else omit section entirely.) **Investigations:** **Bloodwork**: [Include any blood tests, by first writing the date, then followed by the test results] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Imaging**: [Include any imaging tests, by first writing the date, then followed by the test results] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Procedures**: [Include any procedures such as subcutaneous injections, sublingual immunotherapy starts or food or medication challenges, including the food or medication involved, the dosing, monitoring time, and symptoms due to the challenge, if relevant] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) **Assessment and Plan:** (Write each diagnosis/condition in the form of "**[diagnosis/condition]. **[plan]". Use the following example wording whenever possible as long as there are no contradictions.) **Allergic rhinitis**: [Skin prick testing today was unreliable, and I will further investigate with sIgE testing.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Avoidance measures were reviewed, and written information provided. Non-sedating antihistamines, nasal corticosteroids, and antihistamine eye drops can be used for symptom relief. Prescription for: [prescription names] (Only include if explicitly mentioned in transcript or context, else omit section entirely) was provided. [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") is a good candidate for immunotherapy if symptoms become medically refractory, or if allergy modifying therapy is desired. Based on the pattern of sensitization, [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "the patient") is a candidate for [subcutaneous/sublingual] (Only include if explicitly mentioned in transcript or context, else omit section entirely) immunotherapy. [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") will contact my clinic directly for follow-up if [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "the patient") become interested in immunotherapy. **Sublingual immunotherapy**: [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") is interested in pursuing sublingual immunotherapy. [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") is a candidate for [Acarizax (dust mite)/Itulatek (birch/tree)/Grastek (timothy/grass)] (Only include if explicitly mentioned in transcript or context, else omit section entirely). A sublingual tablet is administered daily from home. A typical course of therapy is for 3 years, which has evidence of ongoing benefit after discontinuation for at least 2 years. The benefits and risks, including of oral pruritus, anaphylaxis and eosinophilic esophagitis were discussed. The first dose of each allergen must be administered in my clinic due to an elevated risk of anaphylaxis. [They will return in follow-up for initiation.] (Only include if explicitly mentioned in transcript or context, else omit section entirely.) **Subcutaneous immunotherapy**: [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") is interested in pursuing subcutaneous immunotherapy. There is typically 6-9 months of weekly build-up injections, followed by monthly maintenance injections. Benefit is expected within 1-2 years. A typical course is 3-5 years, after which there should be lasting effect. Risks include life-threatening anaphylaxis were discussed. A prescription has been prepared. Once the serum is available, a follow-up visit will be arranged for first injection. [Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") can then continue to receive injections with me, or with yourself if you agree. (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Potential allergic rhinitis**: [In person follow-up will be arranged for skin testing.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Requisition was provided for sIgE testing to identify sensitization pattern.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Non-sedating oral antihistamines, intranasal corticosteroids, antihistamine eye drops can be used for empiric symptom relief. [A prescription for [medication names] (Only include if explicitly mentioned in transcript or context, else omit section entirely) was provided.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Immunotherapy may be an option. (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Non-allergic rhinitis**: [Skin testing today did not clearly identify sensitization to an aeroallergen.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Allergy testing patterns do not fully explain the patient's symptoms.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Requisition was provided to further investigate with sIgE testing.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Rarely, localized IgE production can occur. The differential diagnosis for non-allergic rhinitis is broad, including structural causes, irritant rhinitis, vasomotor rhinitis. Nasal steroids can continue to be used for symptom relief. [If no clear sensitization is found, referral to an otolaryngologist will be considered in follow-up.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Asthma**: [Potential] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Asthma [, well/poorly controlled] (Only include if explicitly mentioned in transcript or context, else omit section entirely). [Pre- and post-bronchodilator spirometry requisition was provided.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Recommended treatment: [Symbicort 200mcg PRN/Salbutamol PRN/Symbicort 200mcg 1 inh BID + PRN/Flovent 50/125/250mcg 1 inh BID/Alvesco 200mcg 1 inh daily/Atectura 80/160/320mcg 1 inh daily/Breo 100/200mcg 1 inh daily/Enerzair 160mcg 1 inh daily.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Written asthma action plan was provided.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Poorly controlled asthma is a contraindication for immunotherapy. Routine vaccination, including with influenza, COVID-19 and RSV, is recommended if applicable. [[Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") is a candidate for biologics given frequency of exacerbations. Requisition was provided for screening bloodwork to determine eligibility.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Food allergy**: Allergy to [list 1 food to which the patient is allergic, then repeat the following paragraphs as needed for each food] (Only include if explicitly mentioned in transcript or context, else omit section entirely). History, skin testing results [, and sIgE results] (Only include if explicitly mentioned in transcript or context, else omit section entirely) support a diagnosis of IgE-mediated allergy. [Requisition was provided for confirmation with sIgE testing.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [If sIgE results are borderline, in person follow-up for diagnostic confirmation with graded oral challenge will be considered.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Many children with [egg/milk] (Only include if explicitly mentioned in transcript or context, else omit section entirely) allergy can still tolerate extensively baked forms. The Canadian [Egg/Milk] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Ladder(s) was/were provided for guidance on gradual reintroduction of increasingly raw forms. I hope to reassess progress every 6 months.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Outside of treatment,] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Strict avoidance was recommended. Epinephrine autoinjector should be carried at all times. [EpiPen (Jr) was prescribed.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) **Oral immunotherapy**: [Patient name] (Use patient name if available, otherwise use "The patient") is a candidate for oral immunotherapy. Specific amounts of foods of concern will be given on a daily basis, with monthly updosing visits over the course of 1 year. A maintenance dose at around 300mg of food protein will then be consumed for 1-2 years. Sensitization will then be re-evaluated, and an oral challenge considered. The goal of therapy is increasing the reaction threshold. Long-term effects on prognosis is not well known. Risks including anaphylaxis and eosinophilic esophagitis were discussed. Outside of OIT, the foods should not be eaten. [[Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") will return for initiation in follow-up.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [[Pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "The patient") will contact to initiate follow-up if [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "the patient") become interested.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Introduction of common allergenic foods**: Early introduction and regular consumption of allergenic foods are the best ways to protect against food allergy. The list of common allergenic foods foods was reviewed. Written information was provided. [I will review progress in follow-up.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Oral allergy syndrome**: In this condition, proteins in fruits and vegetables mimic pollen proteins, and thus cause a localized allergic reaction. These proteins are heat and acid labile, and cooked forms of are typically tolerated. Patients also do not typically develop systemic symptoms such as anaphylaxis. Affected foods should be avoided in raw forms. Written information was provided. (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Atopic dermatitis**: Principles of eczema management were reviewed and written information was provided. Regular moisturizing was recommended for prevention of flares. Topical medications should be aggressively used when flares develop, to minimize complications such as post-inflammatory hyperpigmentation and skin infections. [Prescription for: [medication names] (Only include if explicitly mentioned in transcript or context, else omit section entirely) was provided.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [We discussed that current understanding of eczema does not support food allergy as a driver. Avoidance of foods should be minimized as it can then lead to IgE-mediated food allergy.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Eosinophilic esophagitis**: [[Patient name] (Use patient name if available, otherwise use "The patient") has a biopsy proven diagnosis of EoE.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Management approaches include dietary elimination and pharmacologic treatment. With dietary elimination, options including 2-food elimination diet, 4-food elimination diet, 6-food elimination diet and elemental diet are available, with varying success rates from 40-80%. Of note, skin test results-guided elimination diets do not have more success. Given the large number of foods involved, restrictive diets themselves can have impact on quality of life. [[Patient name] (Use patient name if available, otherwise use "The patient") decided to proceed with the [name of the diet] (Only include if explicitly mentioned in transcript or context, else omit section entirely), which includes [foods involved] (Only include if explicitly mentioned in transcript or context, else omit section entirely), and expand further if necessary.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [[Patient name] (Use patient name if available, otherwise use "The patient") does not believe that dietary elimination would be practical for [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "their") lifestyle.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Pharmacologic management options include PPIs, swallowed budesonide and escalation to dupilumab if needed. In light of ongoing symptoms, I have initiated therapy with [medication name and dose] (Only include if explicitly mentioned in transcript or context, else omit section entirely). [I will reassess pharmacotherapy in [time] (Only include if explicitly mentioned in transcript or context, else omit section entirely).] (Only include if explicitly mentioned in transcript or context, else omit section entirely) (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Acute urticaria**: In many individuals this is either spontaneous or viral induced. [Urticaria that lasts for over 24 hours are almost always not driven by allergy.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Some patients may also develop angioedema, which is a manifestation of the same interstitial edema in lower levels of the dermis. The condition is not life-threatening and usually improves after few days to few weeks. Laryngeal angioedema is not expected. [Patient name] (Use patient name if available, otherwise use "The patient") was advised to keep at detailed food and medication diary if symptoms recur to ensure an allergic cause is not missed. Management is aimed at symptomatic control with nonsedating antihistamines. (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Chronic spontaneous urticaria**: Up to 40% of patients will also develop non-life-threatening angioedema that does not involve the larynx. [[Patient name] (Use patient name if available, otherwise use "The patient") also has [symptomatic dermatographism/cholinergic urticaria/cold-induced urticaria] (Only include if explicitly mentioned in transcript or context, else omit section entirely) a form of chronic inducible urticaria triggered by [pressure on the skin/increases in body temperature/contact with cold] (Only include if explicitly mentioned in transcript or context, else omit section entirely).] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Chronic nature of the condition was reviewed. In many individuals this condition is due to an autoimmune process in which autoantibodies our directed against the mast cells. This is a self-limiting condition but can take months to years to subside. [Blood work for associated conditions has been ordered.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Management is aimed at symptomatic control. The medications should continue to be used until the urticaria spontaneously resolves. First line treatment is with non-sedating antihistamines at up to 4x labelled dose. If not responding to high-dose antihistamines than omalizumab or cyclosporin would be options. Short course of oral corticosteroids can be used for severe exacerbations. [A prescription for [medication name] (Only include if explicitly mentioned in transcript or context, else omit section entirely) was provided.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) Advised to avoid NSAIDs and alcohol which can exacerbate the condition. (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Penicillin allergy**: Penicillin allergy is commonly reported (around 10% of the population), but most patients with a penicillin allergy label can tolerate penicillin. This is most commonly secondary to misattributed symptoms due to other comorbidities. Sensitization can also be lost over time (80% in 10 years). A penicillin allergy label is associated with multi-drug resistant organisms, and prolonged hospital stays. [Given remote reaction with low risk features, direct oral amoxicillin challenge is recommended. Amoxicillin will be administered, and [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "the patient") will be monitored for 1 hour for features of immediate hypersensitivity.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) [Given elevated risk from history, we will first proceed with intradermal skin testing to penicillin and its derivatives. If skin testing is negative, oral challenge to amoxicillin will be considered.] (Only include if explicitly mentioned in transcript or context, else omit section entirely) The risks and benefits were discussed, and [Patient name] (Use patient name if available, otherwise use "the patient") is agreeable with proceeding when [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "they") returns in follow-up. If [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "they") is asymptomatic, [pronoun] (Use appropriate pronoun based on patient's gender, otherwise use "they") has the same risk of penicillin allergy as the general population, and the allergy label can be removed. (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.) **Follow-up**: [details of follow-up plan for the patient] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a single line.) Thank you for the opportunity to be a part of his care. Please do not hesitate to contact with any questions or concerns. **_"The patient provided verbal consent to use the AI scribe during this visit, understanding its purpose, potential benefits, and as well as any associated privacy and security risks."_** (Never come up with your own patient details, assessment, plan, interventions, evaluation, or plan for continuing care - use only the transcript, contextual notes, or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs, or bullet points, depending on the format, as needed to capture all the relevant information from the transcript. If patient demographics are not clearly stated, omit demographic placeholders rather than guessing. Use only information explicitly discussed - never infer or assume details not mentioned.)