DERMATOLOGY FILES

DERMO_2

LETTER

Date

Name

Address

City, State, Zip

To Whom It May Concern.

I am sending you this registered letter so that I have legally discharged to you my responsibility in regard to the skin cancer which we discussed on your last visit.  My office manager advises me that you are currently trying to arrange some sort of insurance coverage.

It is my obligation to advise you clearly that this tumor is a cancer, that it should be treated promptly, in my opinion within the next 4 to 6 weeks.  I have already discussed with you at length the treatment which I feel is appropriate, that is, excision under frozen control and closure with an advancement flap.  Delay in having this done can result in a less satisfactory cosmetic result, greater expense, and, if it is delayed long enough, could result in a tumor which becomes unresectable and could lead to severe disfigurement, and in very rare cases these tumors have, when uncontrolled, resulted in a patient’s death.

I therefore have no obligation to urge you to seek prompt treatment in regard to this lesion.

Very truly yours

Name.

DERMO_3

HISTORY AND PHYSICAL EXAMINATION

HISTORY:  This 17-year-old was admitted by the emergency room.  She gives a history of shooting crank.

Since that time the left antecubital space has been infected.

PAST HISTORY:  Patient has been shooting for at least a year.

She denies use of drugs other than crank.

The patient has a 2-year-old and a 3-week-old child, has been in the hospital only for that.  Denies accidents, injuries, or other infections.

SOCIAL HISTORY:  Patient is a 17-year-old IV drug user.

PHYSICAL EXAMINATION

VITAL SIGNS:  Temperature 102.2 degrees.  Pulse 112.  Respirations 20.  Blood pressure 104/60.

GENERAL:  Well-developed, well-nourished, English-speaking, Caucasian 17-year-old.

EENT:  No gross abnormalities.  Pupils constricted.  Fair dental repair.

NECK:  Neck supple, no palpable nodes.

CHEST:  Lungs are clear.

HEART:  Heart regular, not enlarged, no murmurs.

BREASTS:  Normal.

ABDOMEN:  Soft.  No palpable masses.

PELVIC AND RECTAL:  Not done.

ORTHOPEDIC:  Examination of the left antecubital space reveals there is a generalized area of tender cellulitis with a moderate amount of swelling on the left as compared with the right.

X-RAYS:  No x-rays are available for review.

DIAGNOSES

1.  Chronic IV (intravenous) drug user.

2.  Cellulitis, left arm.

PLAN:  The patient should be admitted to the hospital for IV antibiotics and possible opening of the wound.

DERMO_4

LETTER

Date

Name

Address

City, State, Zip

Re:

Gentlemen

The patient returned to our office and had 17 intracutaneous tests to reaffirm that he was allergic or not allergic to some additional allergens.  We also performed a set of allergy tests by the epicutaneous method.  We discussed giving allergy injections for those allergens which were unavoidable.

I then gave him his first allergy shot divided up into his left and right arm.

I felt that I had communicated why he was going to be getting allergy injections and why we were going to try to improve his chronic sinusitis problem.

The next day the patient stopped payment for his $76 charge.

I think that, as a practicing allergist who is board-certified, I personally provided an adequate examination as well as an adequate allergy testing, both epicutaneous and intracutaneous, as well as consultation services.  He was also given his first allergy injection, and he was made fully aware of all the problems related to injections.

I hope that this establishes some additional information concerning this problem.

Sincerely yours

Name.