FINAL

Washington County - Memorial Hospital

300 Health Way, Potosi, MO 63664
573-438-5451
Patient: BLANKENSHIP, LARRY W
DOB: 09/24/1980 42 year/M Wt: 390 lb(177 kg) Stated; Ht: 75 in(191 cm)
MRN: 268176 PROVIDER: Kelly Hartel, MD
Acct #: 10291656 Printed: 02/09/2023 02:02
DOS: 02/07/2023 11:48 Page 1 of 3
PCP SUMMARY
CHIEF COMPLAINT:
Shortness of breath
HISTORY OF PRESENT ILLNESS:
This patient is a 42 year old male who presents with a chief complaint of Shortness of
breath. Provider assessment time was 02/07/2023 11:48. I reviewed the vital signs, the
oxygen saturation result and the nursing/ treatment notes and I agree with what is
documented. I agree with the chief complaint selected for this patient''s chart. The onset
was day(s) prior to arrival. The symptoms came on gradually. The duration of the
symptoms has been constant since onset. The cough is productive of yellow sputum. The
symptoms are worsened with exertion, lying flat and some red to rusty sputum. The
symptoms are improved with an inhaler. The shortness of breath was noted to be moderate.
The cough was described as mild. The symptoms developed while at rest and with light
exertion. There is a history of congestive heart failure. The patient is currently taking
inhaled bronchodilators. There is a history of having had a similar problem in the past. The
reported diagnosis was congestive heart failure. Coronary artery disease risk factors
include hypertension and a smoking history. Pulmonary embolus risk factors include
obesity and smoking. The patient has not traveled outside of the United States. The patient
has not had contact with anyone who has traveled outside of the United States within the
last 30 days. Patient meets criteria for potential additional screening criteria for:
COVID-19. Positive Travel Screen Interventions initiated: patient wearing a surgical mask
and appropriate Precautions implemented. There was associated cough and leg swelling.
There was no associated numbness. There was associated chest pain described as sharp and
squeezing. Other History / Staff Note: lower sternal to bilateral lower rib margins
-[KH@02/08/2023 23:49].
ORDERS WITHOUT RESULTS:
Placed Orders:
EKG - (Verbal from K. Hartel MD) Placed at 02/07/2023 12:16, Rinker, M. , RN;
Completed at 02/07/2023 12:07, Rinker, M. , RN; Reviewed at 02/07/2023 17:46,
Hartel, K. , MD; Resulted at 02/07/2023 17:47, Hartel, K. , MD; K. Hartel at
02/07/2023 17:46 Interpretation ABNL. ; K. Hartel @ 02/07/2023 17:47
Acknowledged and Reviewed.
BNP - (Verbal from K. Hartel MD) Placed at 02/07/2023 12:16, Rinker, M. , RN;
Completed at 02/07/2023 12:59, Rinker, M. , RN; Reviewed at 02/07/2023 16:37,
Hartel, K. , MD; Resulted at 02/07/2023 12:59, ; K. Hartel at 02/07/2023 16:37
Interpretation ABNL.
CBC with diff - (Verbal from K. Hartel MD) Placed at 02/07/2023 12:16, Rinker,
M. , RN; Completed at 02/07/2023 12:36, Rinker, M. , RN; Reviewed at 02/07/2023
16:37, Hartel, K. , MD; Resulted at 02/07/2023 12:36, ; K. Hartel at 02/07/2023
16:37 Acknowledged and Reviewed.
Patient: BLANKENSHIP, LARRY W

DOB: 09/24/1980 42 year/M Wt: 390 lb(177 kg) Stated; Ht: 75 in(191 cm)
MRN: 268176 PROVIDER: Kelly Hartel, MD
Acct #: 10291656 Printed: 02/09/2023 02:02
DOS: 02/07/2023 11:48 Page 2 of 3
CMP - Select: Non Fasting (Verbal from K. Hartel MD) Placed at 02/07/2023
12:16, Rinker, M. , RN; Completed at 02/07/2023 13:18, Rinker, M. , RN; Reviewed
at 02/07/2023 16:37, Hartel, K. , MD; Resulted at 02/07/2023 13:18, ; K. Hartel at
02/07/2023 16:37 Acknowledged and Reviewed.
CHEST PORTABLE - Is the Patient on O2? No Is the Patient on IV? No Is the
Patient pregnant? No (Verbal from K. Hartel MD) Mode of transport: WC;
Indications: Shortness of breath; Placed at 02/07/2023 14:31, Rinker, M. , RN;
Completed at 02/07/2023 14:50, Rinker, M. , RN; Reviewed at 02/07/2023 16:37,
Hartel, K. , MD; Resulted at 02/07/2023 14:50, ; K. Hartel at 02/07/2023 16:37
Acknowledged and Reviewed. ; Interpreted by ED physician.
WCMH COVID-19, NAAT - (Verbal from K. Hartel MD) Placed at 02/07/2023
14:33, Rinker, M. , RN; Completed at 02/07/2023 15:04, Rinker, M. , RN; Reviewed
at 02/07/2023 16:37, Hartel, K. , MD; Resulted at 02/07/2023 15:04, ; K. Hartel at
02/07/2023 16:37 Interpretation WNL.
NEB INITIAL Tx - Frequency: X1 (Verbal from K. Hartel MD) Placed at
02/07/2023 15:40, Rinker, M. , RN; Completed at 02/07/2023 15:55, Jones, C. , RT
Albuterol 2.5mg/3ml neb sol - 1 unit dose Nebulization (Verbal from K. Hartel
MD) Placed at 02/07/2023 15:40, Rinker, M. , RN; Completed at 02/07/2023 15:55,
Jones, C. , RT
Atrovent 2.5ml UD 0.02% - 1 unit dose Nebulization (Verbal from K. Hartel MD)
Placed at 02/07/2023 15:40, Rinker, M. , RN; Completed at 02/07/2023 15:55,
Jones, C. , RT
Troponin I, High Sensitivity Placed at 02/07/2023 16:38, Hartel, K. , MD;
Completed at 02/07/2023 17:17, Rinker, M. , RN; Reviewed at 02/07/2023 17:44,
Hartel, K. , MD; Resulted at 02/07/2023 17:17, ; K. Hartel at 02/07/2023 17:44
Acknowledged and Reviewed.
Troponin I, High Sensitivity Placed at 02/07/2023 16:38, Hartel, K. , MD;
Completed at 02/07/2023 17:21, Rinker, M. , RN; Reviewed at 02/07/2023 17:44,
Hartel, K. , MD; Resulted at 02/07/2023 17:21, ; K. Hartel at 02/07/2023 17:44
Acknowledged and Reviewed.
Furosemide 40mg/4ml inj (Lasix) * - 40 mg IVP Placed at 02/07/2023 17:05,
Hartel, K. , MD; Completed at 02/07/2023 17:15, Rinker, M. , RN
PROCEDURES:
EKG - 2/7/2023 12:16:00 PM
IMPRESSION:
HEART FAILURE, UNSPECIFIED
CARDIOMYOPATHY, UNSPECIFIED
DISPOSITION (PHYS):
The disposition time decision was 02/07/2023 17:48.
Discharge.
Discharge: The patient was discharged to Home. The patient''s condition upon discharge
was fair. Education was provided to the patient in reference to the final impressions,
Diagnostic study results, treatment, prognosis and need for follow up. Based on the
medications I am prescribing, I have made any necessary changes to the patients
medications.
Patient: BLANKENSHIP, LARRY W

DOB: 09/24/1980 42 year/M Wt: 390 lb(177 kg) Stated; Ht: 75 in(191 cm)
MRN: 268176 PROVIDER: Kelly Hartel, MD
Acct #: 10291656 Printed: 02/09/2023 02:02
DOS: 02/07/2023 11:48 Page 3 of 3
Instructions given to the patient: Congestive Heart Failure (CHF), Cardiomyopathy and
the patient was advised to return if worsening or increasing symptoms or return as needed.
Follow up provider: Personal Physician, ,.
Follow up: As soon as possible.
Prescriptions: ALBUTEROL 90 MCG INHALER Administer 2 puff(s) every 4 hours
Per MDI As needed for shortness of breath or cough or wheezing Dispense: 1 MDI
Generic allowed No refills Rx Num 157164