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This this is a letter for elsa heriman h e r r I m a n alpha310849 blood test june 2025 crp 2 creatinine 70 lft is normal magnesium normal ferritin normal full blood count normal hi is that elsa herriman hi my name's rob I'm 1 of the gastroenterology doctors here at sherifford hi how are you good have I called you at a reasonable time oh that sounds lovely nice in the sun it's boiling isn't it absolutely boiling yeah are you ready to get out in the sun have you got any plans lovely that sounds nice how have you been from from a bowel perspective how's your stoma working and things like that great of course brilliant I'm glad and it's crohn's disease that affected both your small bowel and your: but then you've had your: removed so there's no need to do any surveillance tests or anything like that and I hope that's been explained to you in the past yep good brilliant so we're just guided by your symptoms really and and how you're feeling and and we're sure to hear you're you're feeling well yeah of course yep okay and you're particularly at risk with your crohn's disease yeah you had osteopenia exactly yeah no no completely it it's difficult to say it's I mean I think your recent blood tests haven't shown any signs that we normally associate with low calcium in terms of the liver tests are fine your iron tests are fine in in usually means that you're absorbing you know your micronutrients relatively well and you're not anemic or anything like that which is reassuring but we didn't check your vitamin d that time in terms of a boat from a bone health perspective I think you're I think you're right that we should repeat that and I think 5 years is a good time good time to repeat that so I can arrange that for you yeah it was 20 it was 2,000 yeah just looking at it a new osteo clinic yeah yeah so I think it'd be worth repeating that because there's always the risk that your bones have got worse and we've got some more treatment we can give off in terms of medicine to shift more calcium into your veins and strengthen the back okay that's good fine complete I hope so no completely yeah no I think it sounds like you're doing all the right things estrogen really helps the adcal d 3 that you're taking really helps but yeah reassessing it I think would be really good I'll book that for you in terms of in terms of your stoma output how how much sort comes out okay fair enough are you using it fine good yeah that's really sensible know where you're at do you know when you're getting a bit bit dry because of it and you know what to do not drinking copious amounts of water having some diarrhea exactly right yeah good brilliant fine great and so I'll book you that phone density scan you had some blood tests a couple of days ago and as I say they're they're pretty good they didn't show any sign of inflammation all the numbers are within range your iron level's good you're not anemic at all reassuring losing weight at all or how's your weight doing brilliant good we we're very happy when people don't lose weight so we'd be very happy with you keeping on putting on weight brilliant anything I've forgotten of course yep I'll put you another dexa scan we'll see what it comes back as if you're still osteopenic or caries as we are if you develop osteoporosis then we'd like to suggest some alendronic acid which is a medicine to help you absorb extra calcium and put it in your bones so we can talk all about that once your test comes back need it and I'll write to you with the result of the scan brilliant if and we'll see you again in we'll talk to you again in 12 months time shall we just to make sure exactly I was gonna say if you need to see us in the meantime we're always here so just get in contact with the nurses or the secretaries whichever 1 and we can arrange to talk to you there okay brilliant nice to talk to you enjoy the sun thank you you too talk to you later bye bye so plan number 1 dexa scan number 2 follow-up in 12 months number 3 flare advice contact ibd nurses number 4 12 month follow-up dear gp I had the pleasure of speaking on the telephone to miss herriman missus herriman today on behalf of doctor klimova k l I m o v a in gastroenterology clinic full stop <\n\n> Her crohn's disease has been stable lately as long as she's careful with her diet full stop she tends to keep her stoma slightly looser and this does sometimes require to use some dioralite particularly when the weather is hot but she's happy with this arrangement and it seems to be working well for her as her weight is stable or slightly increasing full stop <\n\n> Her recent blood tests are very reassuring with all electrolytes in range no anemia and good iron levels full stop <\n\n> She very reasonably is concerned about bone density she's recently started an hrt patch which she hopes will improve her bone density but she was osteopenic 5 years ago full stop <\n\n> I think 5 years is a sensible time to repeat this given her inflammatory bowel disease and if she's osteoporotic we are likely to recommend a bisphosphonate to ameliorate this full stop <\n\n> We'll follow her up in 12 months time but I'll write sooner with the results of the dexa scan and she's always welcome to contact the secretaries or the inflammatory bowel disease nurses at any time if she's flaring or want some advice yours sincerely

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Medical ST5 Miller Clerking
[Current Date] [Current Time]

Presenting Complaint:
[The reason for attendance in 1-3 words]

History of Presenting Complaint:
[Chronological narrative of current illness using short, clear sentences. Include:
- Onset, character, location, radiation, timing, exacerbating/relieving factors
- Associated symptoms
- Impact on daily activities
- Previous similar episodes
- Relevant collateral history from relatives/carers
- Any relevant background from other healthcare professionals
Do not repeat patient's name throughout. Be concise and tell a chronological story to the reader. Do not include subjective descriptions of the symptoms e.g. "severe" or use unnecessarily long words.]

Past Medical History:
[Bulleted list of significant medical conditions with relevant details:]
• [Condition with year if mentioned]
• Diabetes mellitus - latest HbA1c: [value] mmol/mol ([date])
• Asthma/COPD - latest spirometry: FEV1 [value], FVC [value] ([date])
• [Previous surgeries with dates]
• [Other significant medical history]

Drug History:
• [Drug name] [dose][units] [route] [frequency]
• [Example: Omeprazole 20mg PO OD]
• [Example: Clopidogrel 75mg PO OD]

Recently Stopped Medications: [If relevant]
• [Medication] - stopped [date/reason]

Allergy History:
[If allergies mentioned:]
• [Allergen] - [Reaction type] ([severity if mentioned])
• NKDA [if no known drug allergies stated]

Social History:
[Living situation. Who they live with, housing type, if mentioned]
[Mobility. Walking aids, stairs, transfers, if mentioned]
[Carers. Formal/informal care arrangements, if mentioned]
[Occupation. Current/previous if relevant, if mentioned]
[Smoking. Never/Ex-smoker/Current - pack years if mentioned]
[Alcohol. Units per week/Never/Ex-drinker - if mentioned]
[Functional Status: Impact on activities of daily living, if mentioned]

On Examination:
[General Appearance. Alert, well/unwell, distressed, if mentioned]
Observations:: [If mentioned - HR, BP, Temp, RR, O2 sats (do not use subscripts)]
• Abdomen: [Inspection, palpation, percussion, auscultation findings. If not commented upon, document as normal]
• Cardiovascular: [Heart sounds, murmurs, peripheral pulses, oedema. If not commented upon, document as normal]
• Respiratory: [Chest expansion, percussion, auscultation. If not commented upon, document as normal]
• Neurological: [If examined.]
• Other: [Any other relevant examination findings, if mentioned]

Investigations:
• [Test name] ([date, if mentioned, do not include include today's date on results, list without a date]): [Result without units]
• [Example: Hb 85]
• [Imaging type] ([date, if mentioned]): [Key findings]
• [Example: CT Abdomen/Pelvis (15/03/24): Sigmoid diverticulosis, no perforation]

Impression:
[Main diagnosis]
Differential Diagnoses: [Only if multiple possibilities discussed]
[Secondary issues. Relevant comorbidities affecting management. If mentioned]

Management Plan:
1. [A numbered list documenting the management plan to be undertaken, if mentioned, include:
- Immediate management/monitoring,
- Investigation requests,
- Treatment interventions - medications, procedures,
- Discharge planning/follow-up arrangements,
- Patient education/lifestyle advice,
- Referrals to other specialties if needed,
- Which ward or specialty the patient would be best admitted to e.g. "Respiratory Bed",
- Escalation plan that was discussed - whether the patient is suitable for CPR, ITU and/or NIV.]

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