PMH Synthesize — DermSpX

Synthesized PMH (would be written to `notes_test.summaries`)

note (synthesized)

- **Patient Information:**
  - Name: Owen Davies
  - DOB: 03/20/1968
  - MRN: 12640
- **Past Medical History:**
  - ID=1059
  - Reason=scan, wait
  - Location=enire body
  - Notice=few days
- **Family History:**
  - ID=1059
- **Pathology History (10 events):**
  - **2004-09-27:** Posterior Neck — INTRADERMAL NEVUS, BENIGN
  - **2004-09-27:** left posterior neck — INTRADERMAL NEVUS, BENIGN
  - **2004-09-27:** right posterior neck — INTRADERMAL NEVUS, BENIGN
  - **2004-09-27:** right upper back — INTRADERMAL NEVUS, BENIGN
  - **2004-09-27:** ? — TBU
  - **2008-08-18:** Left mid back — CLARK’S NEVUS, COMPOUND TYPE
  - **2008-08-18:** ? — TBU
  - **2011-05-25:** Left upper arm — COMPOUND NEVUS
  - **2011-05-25:** Left upper back — LENTIGINOUS COMPUND MELANOCYTIC NEVUS WITH ARCHITECTURAL AND CYTOLOGICAL ATYPIA
  - **2011-05-25:** ? — TBU
- *Source: 10 extracted path events; 2 pathology PDFs on file. CSC pipeline data: see surveillance section above.*

rx (synthesized)

- **Recent Prescriptions:**
  - **2016-06-27:** halobetasol 0.05% ointment BID to affecte areas
  - **2012-02-14:** Halog Ointment 0. 1 % apply BID
  - **2011-05-25:** Nizoral 200 mg po q am x two days 1.5hrs before exercise
  - **2005-11-07:** Protopic ointment 0.03% apply BID
  - **2004-09-27:** Nizoral 200 mg po q am x one day 1.5hrs before exercise
  - **2002-01-08:** Nizoral 100 mg, 2 tabs po q am x two days 1.5hrs before exercise
  - **2001-04-19:** EMLA cream

code (synthesized)

- **Recent ICD/CPT Codes:**
  - **2021-06-29:**
    - ICD: D22.9 Melanocytic Nevi unspecified
    - CPT: 99213 Return Visit
  - **2021-06-23:**
    - ICD: D22.9 Nevus, unspecified site
    - CPT: 96904 Whole Body Photography
  - **2020-07-01:**
    - ICD: D22.9 Melanocytic Nevi unspecified
    - CPT: 99213 Return Visit
  - **2020-06-24:**
    - ICD: D22.9 Nevus, unspecified site
    - CPT: 96904 Whole Body Photography
  - **2019-07-01:**
    - ICD: D22.9 Melanocytic Nevi unspecified, D22.9 Melanocytic Nevi unspecified
    - CPT: 99213 Return Visit, 96904 Whole Body Integumentary Photography
  - **2018-06-26:**
    - ICD: D22.9 Melanocytic Nevi unspecified, D22.9 Melanocytic Nevi unspecified
    - CPT: 99213 Return Visit, 96904 Whole Body Integumentary Photography
  - **2016-06-27:**
    - ICD: D22.9 Melanocytic Nevi unspecified, L30.1 Dyshidrotic Eczema
    - CPT: 99214 Return Visit
  - **2015-04-09:**
    - ICD: v50.1 Cosmetic Procedure
    - CPT: 96904 Whole Body Photography, 17110  Destruction, skin, up to 14
  - **2013-10-28:**
    - CPT: 96904 Whole Body Photography
  - **2012-05-23:**
    - CPT: 96904 Whole Body Photography
  - **2012-02-14:**
    - ICD: 691.8 Atopic
    - CPT: 99213 Return Visit
  - **2011-05-25:**
    - ICD: 111.0 Tinea Versicolor, 216.9 Atypical Nevus, 216.9 Atypical Nevus
    - CPT: 99213 Return Visit, 11100  BIOPSY, 11101 Biopsy each add'l

Existing summary (visit 2024-08-15)

note (existing — what Dermatoscan reads now)

### Patient Information:
- **Name:** Not provided
- **Date of Birth:** March 20, 1968
- **Age:** 53 years old (as of the latest visit in 2021)
- **Gender:** Male
- **Occupation:** Programmer
- **Height:** 6' 0"
- **Weight:** 185 lbs (consistent across multiple visits)
- **Hair Color:** Brown
- **Eye Color:** Brown
- **Allergies:** None known (NKDA)
- **Tobacco Use:** No
- **Family History:** No significant family history of melanoma or diabetes

### Medical History:
- **Skin Conditions:**
  - Dysplastic nevus syndrome
  - Tinea Versicolor
  - Verruca vulgaris (warts)
  - Molluscum contagiosum
  - Nummular eczema
  - Dyshidrotic eczema vs. contact dermatitis
  - Actinic cheilitis
- **Risk Factors:**
  - Moderate risk for skin cancer (Skin Cancer Risk Assessment: 11 in earlier years, later noted as low)
  - Outdoor sports enthusiast (boating, snow skiing, etc.)

### Key Visits and Findings:
1. **2001-04-19:**
   - **Reason:** Rash on groin and right upper leg
   - **Findings:** Molluscum contagiosum
   - **Treatment:** Fine needle extrication

2. **2001-11-07:**
   - **Reason:** Extra warts and mole question
   - **Findings:** Verruca vulgaris on knee and foot
   - **Treatment:** LN2 treatment

3. **2002-01-08:**
   - **Reason:** Rash, possibly psoriasis
   - **Findings:** Tinea Versicolor
   - **Treatment:** Nizoral 200 mg

4. **2004-09-27:**
   - **Reason:** Checkup and mole evaluation
   - **Findings:** > 50 nevi, some with significant atypia
   - **Treatment:** Biopsies and melanoma education

5. **2005-11-07:**
   - **Reason:** Wart removal on knee
   - **Findings:** Verruca vulgaris
   - **Treatment:** LN2 treatment

6. **2008-08-12:**
   - **Reason:** Checkup and melanoscan
   - **Findings:** Verruca vulgaris on finger
   - **Treatment:** LN2 treatment

7. **2011-05-25:**
   - **Reason:** Melanoscan
   - **Findings:** Tinea Versicolor, Dysplastic nevi
   - **Treatment:** Nizoral 200 mg, biopsies

8. **2012-02-14:**
   - **Reason:** Rash on arm and torso
   - **Findings:** Nummular eczema
   - **Treatment:** Clobetasol 0.05% ointment

9. **2015-04-09:**
   - **Reason:** Full body scan
   - **Findings:** > 50 nevi, some with significant atypia
   - **Treatment:** Annual follow-up

10. **2016-06-27:**
    - **Reason:** Melanoscan
    - **Findings:** Dyshidrotic eczema vs. contact dermatitis
    - **Treatment:** Halobetasol 0.05% ointment

11. **2018-06-26:**
    - **Reason:** Full body scan
    - **Findings:** > 50 nevi, some with significant atypia
    - **Treatment:** Annual follow-up

12. **2019-07-01:**
    - **Reason:** Full body scan
    - **Findings:** > 50 nevi, some with significant atypia
    - **Treatment:** Annual follow-up

13. **2020-06-24:**
    - **Reason:** Dermvan scan
    - **Findings:** No high-risk lesions
    - **Treatment:** Annual follow-up

14. **2021-06-23:**
    - **Reason:** Dermvan scan
    - **Findings:** > 50 nevi, some with significant atypia
    - **Treatment:** Annual follow-up

### Summary:
The patient has a long history of skin conditions, primarily involving various types of nevi and eczema. Regular full-body scans and melanoscan evaluations have been a consistent part of his care, with findings often indicating numerous nevi, some with significant atypia. Treatments have included topical medications, biopsies, and cryotherapy. The patient has no significant family history of skin cancer or diabetes and maintains a low to moderate risk for skin cancer. Regular follow-ups and patient education on melanoma have been emphasized throughout his care.

rx (existing)

The prescription record for the patient under the care of dermatologist Dr. Drugge spans from April 19, 2001, to June 27, 2016. Below is a comprehensive summary of the prescriptions:

1. **April 19, 2001:**
   - **Prescription:** EMLA cream
   - **Sig:** Apply one hour before surgery under saran wrap
   - **Dispense:** 30 grams
   - **Refills:** Six

2. **January 8, 2002:**
   - **Prescription:** Nizoral 100 mg
   - **Sig:** Take 2 tablets by mouth every morning for two days, 1.5 hours before exercise with a carbonated beverage
   - **Dispense:** 4 tablets
   - **Refills:** Three

3. **September 27, 2004:**
   - **Prescription:** Nizoral 200 mg
   - **Sig:** Take by mouth every morning for one day, 1.5 hours before exercise with a carbonated beverage
   - **Dispense:** 5 tablets
   - **Refills:** Zero

4. **November 7, 2005:**
   - **Prescription:** Protopic ointment 0.03%
   - **Sig:** Apply twice daily
   - **Dispense:** 15 grams
   - **Refills:** One

5. **May 25, 2011:**
   - **Prescription:** Nizoral 200 mg
   - **Sig:** Take by mouth every morning for two days, 1.5 hours before exercise with a carbonated beverage
   - **Dispense:** 2 tablets
   - **Refills:** Three

6. **February 14, 2012:**
   - **Prescription:** Halog Ointment 0.1%
   - **Sig:** Apply twice daily to affected areas
   - **Dispense:** 60 grams
   - **Refills:** One

7. **June 27, 2016:**
   - **Prescription:** Halobetasol 0.05% ointment
   - **Sig:** Apply twice daily to affected areas
   - **Dispense:** 60 grams
   - **Refills:** Three

Throughout the years, the patient has been prescribed a variety of topical and oral medications, primarily for pre-surgical preparation, fungal infections, and inflammatory skin conditions. The prescriptions include both short-term and long-term treatments with varying refill allowances.

code (existing)

The ICD/CPT code record for the patient under the care of dermatologist Dr. Drugge spans from April 19, 2001, to June 29, 2021. The records detail various dermatological conditions and procedures performed over the years. Below is a comprehensive summary of the findings:

### Summary of ICD Codes:
1. **Molluscum Contagiosum (078.0)**:
   - Dates: 2001-04-19, 2001-04-30, 2001-05-14
2. **Verruca Vulgaris (078.19)**:
   - Dates: 2001-11-07, 2005-11-07, 2008-08-12
3. **Tinea Versicolor (111.0)**:
   - Dates: 2002-01-08, 2011-05-25
4. **Atypical Nevus (216.9)**:
   - Dates: 2008-08-18, 2011-05-25
5. **Nevus (216.9)**:
   - Dates: 2004-09-27, 2008-08-18, 2009-05-04, 2011-05-25, 2020-06-24, 2021-06-23
6. **Atopic Dermatitis (691.8)**:
   - Date: 2012-02-14
7. **Cosmetic Procedure (v50.1)**:
   - Date: 2015-04-09
8. **Melanocytic Nevi, Unspecified (D22.9)**:
   - Dates: 2016-06-27, 2018-06-26, 2019-07-01, 2020-06-24, 2020-07-01, 2021-06-23, 2021-06-29
9. **Dyshidrotic Eczema (L30.1)**:
   - Date: 2016-06-27

### Summary of CPT Codes:
1. **Destruction of Lesions**:
   - 54065 (Extensive Destruction: Penis): 2001-04-19
   - 17110 (Up to 14 Lesions): 2001-04-30, 2001-05-14, 2008-08-12, 2009-05-04, 2015-04-09
   - 17000 (Destruction, Skin): 2001-11-07, 2005-11-07
   - 17003 (Destruction, Skin, 2-14): 2001-11-07
2. **Biopsy**:
   - 11100 (Biopsy): 2004-09-27, 2008-08-18, 2011-05-25
   - 11101 (Biopsy, Each Additional): 2011-05-25
3. **Return Visits**:
   - 99213: 2002-01-08, 2005-11-07, 2008-08-18, 2011-05-25, 2012-02-14, 2016-06-27, 2018-06-26, 2019-07-01, 2020-07-01, 2021-06-29
   - 99214: 2016-06-27
4. **Whole Body Photography**:
   - 96904: 2008-08-12, 2012-05-23, 2013-10-28, 2015-04-09, 2018-06-26, 2019-07-01, 2020-06-24, 2021-06-23

### Observations:
- The patient has had multiple instances of molluscum contagiosum and verruca vulgaris, with treatments involving lesion destruction.
- There have been several biopsies performed, particularly for atypical nevi and other skin lesions.
- The patient has had regular return visits, indicating ongoing dermatological care.
- Whole body photography has been used multiple times, likely for monitoring skin conditions and changes over time.
- The patient has also been treated for tinea versicolor, atopic dermatitis, and dyshidrotic eczema.
- Cosmetic procedures have been documented, indicating a focus on both medical and aesthetic dermatology.

This summary provides a comprehensive overview of the patient's dermatological history and treatments under Dr. Drugge's care.

Provenance

patient_ID	1240
path events (extracted)	10
path PDFs (on file)	2
PITF tables pulled	`patient_history, patient_current_medications, patient_medicine_allergy, patient_family_history, patient_symptoms, patient_cancer_risk_assesments, patient_summary, patient_contacts`
HomePage present	True
chat messages (last)	0
dry_run	True

v0 is deterministic — no LLM. Each format_* function is a mutation surface for the autonomous loop. Audit trail in _provenance; written as :Experiment nodes when the loop is active.

🔬 DermSpX

Synthesized PMH (would be written to notes_test.summaries)

note (synthesized)

rx (synthesized)

code (synthesized)

Existing summary (visit 2024-08-15)

note (existing — what Dermatoscan reads now)

rx (existing)

code (existing)

Provenance

Synthesized PMH (would be written to `notes_test.summaries`)