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Mr. Grant is a 91-year-old male with longstanding cardiovascular disease, including prior MI, CABG, ischemic heart disease, and atrial fibrillation, now complicated by diabetic nephropathy progressing to stage 3 CKD. He also has Alzheimer's disease and chronic multisite pain (back, neck, general chronic pain). He remains on a complex multi-drug regimen including anticoagulation, insulin, and cardiac medications, with frequent recent check-up encounters.
Drives care
- Diabetic nephropathy with worsening CKD (stage 3)
- Ischemic heart disease with prior MI/CABG and atrial fibrillation
- Alzheimer's disease affecting cognition and medication management
- Chronic widespread pain (back, neck, general)
Watch
- Rising creatinine trend (1.94→2.06 mg/dL) over past month - reassess renal function and nephrotoxic meds
- Warfarin + clopidogrel combination - monitor bleeding risk given CKD progression
- Cognitive decline (Alzheimer's) may impact adherence to complex 12-medication regimen
Withheld from this view and from assistant retrieval:
3 × Mental health · 2 × SUD — 42 CFR Part 2.
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Active problems
| Condition | Status | Onset |
|---|---|---|
| Chronic kidney disease stage 3 (disorder) | active | Nov 13, 2016 |
| Proteinuria due to type 2 diabetes mellitus (disorder) | active | Nov 13, 2016 |
| Atrial fibrillation (disorder) | active | Aug 4, 2014 |
| Chronic pain (finding) | active | Feb 4, 2014 |
| Chronic low back pain (finding) | active | Feb 4, 2014 |
| Chronic neck pain (finding) | active | Feb 4, 2014 |
| Alzheimer's disease (disorder) | active | Nov 22, 2009 |
| History of coronary artery bypass grafting (situation) | active | Jun 19, 2007 |
| Abnormal findings diagnostic imaging heart+coronary circulat (finding) | active | Jun 12, 2007 |
| Ischemic heart disease (disorder) | active | Jun 4, 2007 |
| Chronic kidney disease stage 2 (disorder) | active | Aug 7, 2006 |
| Microalbuminuria due to type 2 diabetes mellitus (disorder) | active | Aug 7, 2006 |
| Acute ST segment elevation myocardial infarction (disorder) | active | May 1, 2000 |
| History of myocardial infarction (situation) | active | May 1, 2000 |
| Chronic kidney disease stage 1 (disorder) | active | Oct 27, 1996 |
| Disorder of kidney due to diabetes mellitus (disorder) | active | Oct 27, 1996 |
| Hyperlipidemia (disorder) | active | Jun 17, 1991 |
| Hyperglycemia (disorder) | active | Jun 11, 1990 |
| Essential hypertension (disorder) | active | May 19, 1986 |
| Hypertriglyceridemia (disorder) | active | May 19, 1986 |
| Metabolic syndrome X (disorder) | active | May 19, 1986 |
| Anemia (disorder) | active | May 19, 1986 |
| Diabetes mellitus type 2 (disorder) | active | Oct 27, 1985 |
| Obstructive sleep apnea syndrome (disorder) | active | May 20, 1981 |
| Sleep disorder (disorder) | active | May 1, 1981 |
| Body mass index 30+ - obesity (finding) | active | May 19, 1975 |
| Chronic sinusitis (disorder) | active | Mar 11, 1974 |
| Risk activity involvement (finding) | active | Jun 19, 1950 |
Active medications
| Medication | Dosage | Since |
|---|---|---|
| 24 HR Metformin hydrochloride 500 MG Extended Release Oral Tablet | — | Aug 3, 2026 |
| Acetaminophen 325 MG Oral Tablet [Tylenol] | Every four to six hours (qualifier value) | Aug 3, 2026 |
| Digoxin 0.125 MG Oral Tablet | — | Aug 3, 2026 |
| Hydrochlorothiazide 25 MG Oral Tablet | — | Aug 3, 2026 |
| Warfarin Sodium 5 MG Oral Tablet | — | Aug 3, 2026 |
| amLODIPine 2.5 MG Oral Tablet | — | Aug 3, 2026 |
| insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Injectable Suspension [Humulin] | — | Aug 3, 2026 |
| lisinopril 10 MG Oral Tablet | — | Aug 3, 2026 |
| verapamil hydrochloride 80 MG Oral Tablet [Calan] | — | Aug 3, 2026 |
| Simvastatin 10 MG Oral Tablet | — | Jun 10, 2026 |
| Galantamine 4 MG Oral Tablet | — | Nov 22, 2009 |
| Clopidogrel 75 MG Oral Tablet | — | Jun 11, 2007 |
| Nitroglycerin 0.4 MG/ACTUAT Mucosal Spray | — | Jun 11, 2007 |
| Simvastatin 20 MG Oral Tablet | — | Jun 11, 2007 |
| 24 HR metoprolol succinate 100 MG Extended Release Oral Tablet | — | May 1, 2000 |
| aspirin 81 MG Oral Tablet | — | May 1, 2000 |
| atorvastatin 40 MG Oral Tablet | Take as needed. | May 1, 2000 |
| ramipril 1.25 MG Oral Capsule | Take as needed. | May 1, 2000 |
Allergies
| Substance | Reaction | Verification |
|---|---|---|
| No known allergies recorded. | ||
Recent results
| Test | Value | When |
|---|---|---|
| eGFR | 25.38 mL/min/{1.73_m2} | Aug 3, 2026 |
| HDL cholesterol | 60.66 mg/dL | Aug 3, 2026 |
| LDL cholesterol | 75.78 mg/dL | Aug 3, 2026 |
| Triglycerides | 142.85 mg/dL | Aug 3, 2026 |
| Total cholesterol | 165 mg/dL | Aug 3, 2026 |
| Potassium | 3.8 mmol/L | Aug 3, 2026 |
| Sodium | 138.48 mmol/L | Aug 3, 2026 |
| Glucose | 70.23 mg/dL | Aug 3, 2026 |
| Respiratory rate | 13 /min | Aug 3, 2026 |
| Heart rate | 87 /min | Aug 3, 2026 |
| BMI | 28.08 kg/m2 | Aug 3, 2026 |
| Body weight | 92.9 kg | Aug 3, 2026 |
| Pain severity | 1 {score} | Aug 3, 2026 |
| Body height | 181.9 cm | Aug 3, 2026 |
| Hemoglobin A1c | 2.52 % | Aug 3, 2026 |
| eGFR | 50.813 mL/min/{1.73_m2} | Aug 3, 2026 |
| Creatinine abnormal | 2.061 mg/dL | Aug 3, 2026 |
| Hemoglobin A1c | 2.52 % | Jul 27, 2026 |
| eGFR | 42.558 mL/min/{1.73_m2} | Jul 27, 2026 |
| Creatinine abnormal | 1.99 mg/dL | Jul 27, 2026 |
| HDL cholesterol | 59.83 mg/dL | Jul 20, 2026 |
| LDL cholesterol | 37.55 mg/dL | Jul 20, 2026 |
| Triglycerides | 130.59 mg/dL | Jul 20, 2026 |
| Total cholesterol | 123.5 mg/dL | Jul 20, 2026 |
| Potassium | 4.45 mmol/L | Jul 20, 2026 |
| Sodium | 136.29 mmol/L | Jul 20, 2026 |
| Glucose | 77.87 mg/dL | Jul 20, 2026 |
| Respiratory rate | 14 /min | Jul 20, 2026 |
| Heart rate | 83 /min | Jul 20, 2026 |
| BMI | 28.08 kg/m2 | Jul 20, 2026 |
Notes & documents
| Document | Author | Date | |
|---|---|---|---|
| No unrestricted documents. | |||
Claims
| Claim | Payer | Date | Status | Billed | Paid | |
|---|---|---|---|---|---|---|
| CLM-2026951000 | Humana | Aug 17, 2026 | paid | $110.90 | $20.28 | Lines |
| CLM-2026951002 | Humana | Aug 4, 2026 | paid | $2,730.98 | $2,070.72 | Lines |
| CLM-2026951001 | Humana | Aug 4, 2026 | paid | $129.94 | $0.00 | Lines |
| CLM-2026951007 | Humana | Aug 3, 2026 | paid | $1,199.60 | $0.00 | Lines |
| CLM-2026951006 | Humana | Aug 3, 2026 | paid | $129.94 | $0.00 | Lines |
| CLM-2026951005 | Humana | Aug 3, 2026 | paid | $126.89 | $0.00 | Lines |
| CLM-2026951004 | Humana | Aug 3, 2026 | paid | $85.55 | $2,654.50 | Lines |
| CLM-2026951003 | Humana | Aug 3, 2026 | paid | $85.55 | $0.00 | Lines |
Documentation drafts — this patient
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Imaging
| Study | Modality | Date | Series / images | |
|---|---|---|---|---|
| CR | Jun 18, 2007 | 1 / 1 | Open viewer | |
| US | Jun 18, 2007 | 1 / 1 | Open viewer | |
| DX | Jul 4, 2025 | 1 / 1 | Open viewer |