INITIAL OFFICE EVALUATION HISTORY: Patient is a 49-year-old white female that presents with a history of having acute onset

of right flank pain x 12 hours. Patient awoke this morning with sharp stabbing pain that started at right midback and radiated to the right lower quadrant. There was no nausea, fevers, chills, diarrhea, constipation, rectal bleeding, dysuria, or hematuria. Pain resolved about an hour before she got here. Examination of the back indicates no focal tenderness or spasm. Abdomen indicates minimal discomfort in the right lower quadrant, otherwise, unremarkable. Pelvic: Blind vaginal pouch, no. No pain. Rectal exam: Stool heme, negative. Patient has had a cholecystectomy and a partial hysterectomy with an appendectomy. Urinalysis showed hematuria greater than 100 red cells, 0 to 1 white cells, and occasional bacteria. White cell count was elevated, 14,700. Amylase 57, SGOT 33, x. X-ray (0.50, CAPITALIZATION ERROR) unremarkable. OVERALL IMPRESSION: Hematuria, probably due to the passage of a renal stone, now asymptomatic. PLAN: Ampicillin for prophylactic coverage of potential infection, 500 mg q.i.d. IVP to be ordered, and to be followed up by her physician.

NP: 0.50 LC: 17.89 QA: 97.20%