Lemonaid – Visit Summary

[checkbox name="typevisit" value="PRIMARY CARE VISIT|DEPRESSION/ANXIETY VISIT|ED VISIT|CONTRACEPTION VISIT|SINUSITIS|HYPOTHYROID VISIT|MIGRAINE|URINARY TRACT INFECTION|ASTHMA|INSOMNIA|OTHER"]

SUMMARY OF VISIT
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Thanks for the opportunity to care for you. Here are some of the highlights from our visit:

[select name="changes" value="You will continue on your current treatment plan|You will adjust your treatment plan as discussed|You will start the treatment plan as discussed"]. [text name="text" default=""]

A prescription has been sent to [select name="pharm" value="our pharmacy for home delivery of your medications|your local pharmacy for pickup|your local pharmacy for a temporary supply of medicine as well as to our pharmacy for home delivery"]. Please make sure to read all information sent in your treatment plan and do not hesitate to reach out with any questions or concerns.

[conditional field="typevisit" condition="(typevisit).is('OTHER')"]
[textarea name="othertxt" default=""][/conditional]

[conditional field="typevisit" condition="(typevisit).is('ED VISIT')"]
[select name="dafollowup" value="
TIPS FOR USING VIAGRA (SILDENAFIL)
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Please make sure you are following these tips for success; 

1) REMEMBER to take medication exactly as prescribed.

2) Take medication 60 to 90 minutes before having sex for best results. Having sex too soon after taking the medication means it might not work as well. So the longer you wait, the higher the medication will be in your bloodstream which will equal better results.

3) The medication is most effective when taken on an empty stomach, away from food!

4) If you drink, more than 1-2 drinks of alcohol can reduce effectiveness and increase the chance of side effects so it's best to avoid drinking when you have this medication in your system.|

TIPS FOR USING CIALIS (TADALAFIL)
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How should I take Cialis for the best results?

-Take as directed

-For as-needed dosing, take Cialis at least 30 minutes or more before sexual activity.

-If your prescription involves taking Cialis daily, take it at the same time each day. This maintains steady levels of Cialis in your body.


Take as part of a lifestyle with physical activity

-Smoking, heavy drinking, unmanaged stress, and an unhealthy diet can affect ED as well as how Cialis works, potentially leading to more side effects.

-A healthy diet, increasing physical activity, and quitting smoking are important for wellness, physical health, and can affect the severity of ED.

Strategies to reduce stress and support your relationship with your partner can also improve sexual performance and well-being.

-Communicate and stay relaxed

-Working with a psychiatrist, therapist, or sex therapist can help you navigate strategies for the mental and emotional side of intimacy.

Other ways to improve your sexual performance include managing stress, working through relationship concerns, and treating performance anxiety.

If you’re anxious, stressed, depressed, or nervous, Cialis may not work as well. It’s important to relax and be aroused for the medication to work best.

What should I not take with Cialis?

-High fat foods

-Avoid high fat foods or heavy meals before taking Cialis and before sexual activity. High fat foods can affect how well Cialis works. It may also take longer to work.

-Nitrates and other medications

Some medications can interact with Cialis and change its effectiveness. They include:

	•	nitrates

	•	anti-seizure medications

	•	HIV medications

	•	certain antibiotics

	•	oral anti-fungal medications

	•	high blood pressure medications

Be sure to talk to your doctor or pharmacist about how to take all your medications to avoid interactions.

It’s important to avoid Cialis if you take chest pain (angina) and blood pressure medications in the nitrate category or alpha blocker drugs. They can lower your blood pressure to dangerous levels.

Alcoholic beverages

-Use caution with alcohol consumption when taking Cialis. Too much alcohol can affect your ability to become aroused. It can also cause excessive low blood pressure, leading to headache, dizziness, and fainting.

Grapefruit and grapefruit juice

-Avoid grapefruit with Cialis. It can increase the levels of the medication in the blood, causing increased side effects.

What else is important to know about taking Cialis?

Age

-In some people over 65 years old, Cialis may last longer because it takes more time for your body to process the medication. This affects how soon it leaves your body.

-Poor kidney function can increase Cialis levels in your body, increasing side effects. Your doctor may adjust your dose in this case.

-Heart and other conditions

-If you’re over 65, have a heart condition, or liver- or kidney-related problems, your doctor may need to adjust your dose of Cialis and monitor how the medication works for you.

Fake Cialis

-Avoid buying Cialis without a doctor’s prescription. PDE5 medications are some of the most common counterfeit medications sold online. They can cause serious health risks.

Take as prescribed

-Take Cialis exactly as prescribed by your doctor. Don’t take extra doses or change your dosing schedule without talking with your doctor to avoid side effects."]

[checkbox name="edstock" value="HYPERTENSION / HIGH BLOOD PRESSURE
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Some blood pressure medicines can cause ED, so ask your doctor if a change in medicine might improve your ED. Monitor your blood pressure and if consistently higher than 140/90 you should see a doctor. Left untreated it can lead to premature and preventable heart attack or stroke.  If you have symptoms of headache, chest pain, blurry vision, or other symptoms due to high blood pressure (if it occurs typically a blood pressure of > 160/100) see a doctor right away. As a reminder, this should be something that is under the care of a regular doctor and I encourage you to follow-up with one if you have not already. 

|ELEVATED BLOOD PRESSURE READING
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I noticed that your blood pressure was higher than recommended. It should be less than 140/90. This should be something that is under the care of a regular doctor and I encourage you to follow-up with one if you have not already. Left untreated it can lead to premature and preventable heart attack or stroke.  If you have symptoms of headache, chest pain, blurry vision, or other symptoms due to high blood pressure (if it occurs typically a blood pressure of > 160/100) see a doctor right away.

|HIGH CHOLESTEROL/ STATIN TREATMENT
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High cholesterol can be a risk factor for heart disease and ED could be a first sign of future heart disease. Feel free to use our CHOLESTEROL AND STATIN TREATMENT service. You can get a cholesterol test done if you have not had one done over the past year and see if you need a prescription statin drug to decrease your chance of preventable heart attack or stroke by 20 to 25%. If you have a statin and need a refill, we can provide you a 90 day supply of statin medicine if labs have been done! Too many Americans die of preventable heart attack or stroke because they are not taking a statin medicine.

|DIABETES
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This should be something that is under the care of a regular doctor and I encourage you to follow-up with one if you have not already. Diabetes should be well controlled with a HgbA1c ideally at less than 8. Left untreated it can lead to premature and preventable heart attack or stroke. You should be on a statin medicine. If you are not, get a cholesterol test done if you have not had one done over the past year and see if you need a prescription statin drug to decrease your chance of preventable heart attack or stroke by 20 to 25%. Start a visit in the CHOLESTEROL TEST. Use promo code HIC (all caps) to get $15 off the visit fee. 

|PHYSICAL EXAM RECOMMENDED
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We recommend you see a regular doctor in person if you have NOT had a general physical or check-up in the past 5 years OR if you have any concerns about physical causes for your erectile dysfunction. 

|MEN 25 to 29 Years Old
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The main contributor to erectile dysfunction in this age is typically stress and symptoms that may be associated with anxiety or depression and usually not a true medical condition. Though an ED medicine may be helpful, understanding this is important as medicine alone may not help.

The most important body part in sex is the brain. If you are stressed, anxious, depressed, or fatigued, this can have a role in your erections. Focus on taking your time. Focus on your partner and pleasuring your partner in other ways than just penetration. Focus on just the intimacy of just being close. Expect to practice this on more than one occasion. Avoid alcohol. Work on other aspects of your life, (sleep, exercise), to help improve your stress, anxiety, depression, and or fatigue. 

If these symptoms of anxiety or depression are problems that you have had for a while and are impacting work or home life, you may wish to see a doctor in person to evaluate you which can also impact your erectile dysfunction.    

|MEN 67 Years or Older
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We strongly recommend that all men 67 years or older should be taking a cholesterol lower medicine (statin) every day to decrease risk of premature heart attack or stroke.

If you are currently taking a statin medicine, great!

At 67 years old, the risk of heart attack over the next 10 years with perfect risk factors (i.e. total cholesterol 170, HDL good cholesterol 50, systolic blood pressure 110, and not a smoker, and have no high blood pressure or diabetes) is 10.4%. Anytime this risk is greater than 10% a statin medicine is recommended. At age 72, that risk increases to 15%. If you do not have perfect risk factors, this means your risk is even greater.

Not on a statin? Use our CHOLESTEROL TEST to determine your 10 year risk. 

For all men, we suggest being active for good health. Regular walking of 40 minutes or more per day is a good start."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('DEPRESSION/ANXIETY VISIT')"]
[select name="dafollowup" value="ONE MONTH FOLLOW UP
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Thanks for giving me the opportunity to help you today. As a reminder, here's the process of how the next one month will go.

ONE MONTH PRESCRIPTION: Today, a one month prescription of medications will be sent to the pharmacy of your choice. If you use our Lemonade Pharmacy, it will be shipped to you ASAP. 

FOLLOW UP CONSULTATION IN JUST UNDER 1 MONTH

In just under 1 month from now you'll need to complete a follow-up consultation with me or one of my colleagues. To do this, log into your account and go to the DEPRESSION or ANXIETY click Take the First Step, then select FOLLOW-UP CONSULT for our streamlined questionnaire. Do this when you are down to your last week of medicine.

You can always reach out any time before then if you want to call us during business hours or send us a private message. If we need to adjust your medicines at any time that is easy to do and won’t cost you anything extra as it’s included in your membership.|

TWO MONTH FOLLOW UP
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Thanks for giving me the opportunity to help you today. As a reminder, here's the process of how the next TWO monthly shipments of your medication refills will arrive to you! 

FILL #1 - Today, our pharmacy will be mailing you a ONE month supply of medication. 

REFILL #2 -  In about 3 weeks from when you received your first refill, one of our pharmacists will call you to check everything’s going fine and then mail the refill.  This will be your last refill. You need to do a follow-up visit with us.


FOLLOW UP CONSULTATION IN JUST UNDER 2 MONTHS

In just under 2 months from now you'll need to complete a follow-up consultation with me or one of my colleagues. To do this, log into your account and go to the DEPRESSION or ANXIETY click Take the First Step, then select FOLLOW-UP CONSULT for our streamlined questionnaire. Do this when you are down to your last week of medicine from your REFILL #2.

You can always reach out any time before then if you want to call us during business hours or send us a private message. If we need to adjust your medicines at any time that is easy to do and won’t cost you anything extra as it’s included in your membership.|

THREE MONTH FOLLOW UP
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Thanks for giving me the opportunity to help you today. As a reminder, here's the process of how the next THREE monthly shipments of your medication refills will arrive to you! 

FILL #1 - Today, our pharmacy will be mailing you a ONE month supply of medication. 

REFILL #2 - In about 3 weeks from now, one of our pharmacists will call you to check everything’s going fine and then mail the refill. 

REFILL #3 -  In about 3 weeks from when you received your second refill, one of our pharmacists will call you to check everything’s going fine and then mail the refill.  This will be your last refill. You need to do a follow-up visit with us.

FOLLOW UP CONSULTATION IN JUST UNDER 3 MONTHS

In just under 3 months from now you'll need to complete a follow-up consultation with me or one of my colleagues. 

To do this, log into your account and go to the DEPRESSION or ANXIETY click Take the First Step, then select FOLLOW-UP CONSULT for our streamlined questionnaire. Do this when you are down to your last week of medicine from your REFILL #3.

You can always reach out any time before then if you want to call us during business hours or send us a private message. If we need to adjust your medicines at any time that is easy to do and won’t cost you anything extra as it’s included in the $95/month subscription we’ll bill your card every month."]

[checkbox name="instructions" value="SNRI MEDICATION AND BLOOD PRESSURE
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SNRI medications (Wellbutrin, Effexor, Cymbalta) can cause blood pressure to be higher. If you are taking one of these medications, check your blood pressure periodically (once a month). You can purchase a cuff, get a reading at a provider's office or check at a local pharmacy/grocery store. Your blood pressure should be less than 140/90 and ideally less than 120/80. If you find your blood pressure readings are higher than normal or greater than 140/90, please send us a message with your blood pressure readings and dates taken.

|PTSD
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For post-traumatic stress disorder (PTSD), we strongly recommend counseling as an effective treatment option especially if you have never done it or if taking a prescription is not helping.

|AVOID NSAIDs
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As we discussed, we recommend you do NOT take Nonsteroidal Anti-Inflammatory Agents (NSAIDs), like ibuprofen, naprosyn, at all, even occasionally. These medicines have drug-drug interactions with the medicines we use to treat depression / anxiety which can result in prolonged bleeding."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('SINUSITIS')"]
TIPS FOR TREATING SYMPTOMS OF A SINUS INFECTION
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I do recommend using a non-drowsy antihistamine such as Zyrtec (cetirizine) or Claritin (loratidine) as well as a nasal spray such as Ocean Saline, Nasacort, or Flonase. The pharmacist can assist you in finding these over-the counter-medications. I DO NOT RECOMMEND USING AFRIN AS THIS CAN CAUSE REBOUND SYMPTOMS. If you have a history of high blood pressure, there are certain types of decongestants that are safe to use. One kind is Coricidin HBP. Speak to your pharmacist about finding over the counter medications that would be right for you.

Wait 1 hour before calling the pharmacy and letting them know how you will pay (cash or insurance) and when it will be ready to be picked up.
Read the important TREATMENT PLAN included in this message.

[checkbox name="sinusitisdm" value="IF YOU ARE DIABETIC
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Persons with diabetes can have their blood sugar go up significantly when they have any infection or illness (such as a sinus infection).  If insulin dependent, please monitor your blood sugar carefully.  Signs of very high blood sugar may include but not be limited to intense thirst, very dry mouth, sudden frequent urination, unexpected lethargy and rapid onset blurry vision.  If the following occur please seek immediate attention with a health care provider in person.  If your sinus symptoms persist or worsen, please also follow up with a health care provider in person for further evaluation and treatment."]

[checkbox name="sinusitissmoke" value="SINUS INFECTIONS AND SMOKING
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I see that you smoke. As a medical provider, I recommend you quit smoking. Smoking increases your risk of serious medical problems like premature heart attack, premature stroke, cancer, erectile dysfunction (men only), and other medical problems. Also quitting, decreases your risk of sinus infections and other respiratory infections and problems like emphysema. It's never too late to quit."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('CONTRACEPTION VISIT')"]
[select name="ocp" value="STARTING ORAL CONTRACEPTIVE
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You can start the first pack of birth control pills at any time of your menstrual cycle.  
If you take the first pill within 5 days of the first day of your last menstrual period, you will be protected against pregnancy right away.

 If you take the first pill at any other time of your menstrual cycle, you will need to use a back-up form of birth control for the first 7 days of taking the pill.  Back- up forms of birth control include condoms, diaphragm or sponge.|CONTINUING HORMONAL CONTRACEPTIVES
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If you would like additional information regarding hormonal contraceptives, visit the American College of Obstetricians and Gynecologists (https://www.acog.org/womens-health/faqs/combined-hormonal-birth-control-pill-patch-ring)|CONTRACEPTIVE PATCH
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You can start this medicine anytime, but use a backup method of birth control such as condoms, sponges, or a cervical diaphragm for the first week. 

The patch is a sticker that should be applied to clean, dry, intact skin. Apply a new patch every week for 3 weeks, and then on the fourth week take a patch-free week. Always change the patch on the same day of the week. Remove the old patch before applying the new one. You can place the patch on the buttock, abdomen, upper arm, or upper chest (but not the breast, as it might cause breast tenderness). A different site should be used each time a new patch is applied.|PROGESTERONE ONLY CONTRACEPTION (ERRIN)
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ERRIN is a progestin only birth control pill that is just as effective in preventing unintended pregnancy as combination birth control pills. It DOES need to be taken at the same time every day to provide full effectiveness.

Please review ERRIN profile as it is not the same as combination birth control pills and has different side effects - worsening of acne for some women and/or irregular or unpredictable bleeding. Over time (weeks to months) many women notice they do not get a period with ERRIN which is nothing to worry about."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('MIGRAINE')"]
MIGRAINE HEADACHES
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A migraine is a type of headache. It may occur with symptoms such as nausea, vomiting, or sensitivity to light and sound. In most people, a throbbing pain is felt only on one side of the head.

Causes
A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, have fewer migraines when they are pregnant.

Migraine attacks may be triggered by any of the following:

-Caffeine withdrawal
-Changes in hormone levels during a woman's menstrual cycle or with the use of birth control pills
-Changes in sleep patterns, such as not getting enough sleep
-Drinking alcohol
-Exercise or other physical stress
-Loud noises or bright lights
-Missed meals
-Odors or perfumes
-Smoking or exposure to smoke
-Stress and anxiety
-Migraines can also be triggered by certain foods. 

Most common are:

-Chocolate
-Dairy foods, especially certain cheeses
-Foods with monosodium glutamate (MSG)
-Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
-Fruits (avocado, banana, citrus fruit)
-Meats containing nitrates (bacon, hot dogs, salami, cured meats)
-Onions
-Peanuts and other nuts and seeds
-Processed, fermented, pickled, or marinated foods

True migraine headaches are not a result of a brain tumor or other serious medical problem. Only a health care provider who specializes in headaches can determine if your symptoms are due to a migraine or other condition.

Symptoms
There are two main types of migraines:

-Migraine with aura (classic migraine)
-Migraine without aura (common migraine)

An aura is a group of nervous system (neurologic) symptoms. These symptoms are considered a warning sign that a migraine is coming. Most often, the vision is affected and can include any or all of the following:

-Temporary blind spots or colored spots
-Blurred vision
-Eye pain
-Seeing stars, zigzag lines, or flashing lights
-Tunnel vision (only able to see objects close to the center of the field of view)
-Other nervous system symptoms include yawning, difficulty concentrating, nausea, trouble finding the right words, dizziness, weakness, numbness, and tingling. Some of these symptoms are much less common with migraine headaches. If you have any of these symptoms, your provider will likely order tests to find the cause.

An aura often occurs 10 to 15 minutes before the headache, but can occur just a few minutes to 24 hours before. A headache does not always follow an aura.

The headaches usually:

Start as a dull ache and get worse within minutes to hours
Are throbbing, pounding, or pulsating
Are worse on one side of the head with pain behind the eye or in the back of the head and neck
Last 4 to 72 hours

Other symptoms that may occur with the headache include:

-Chills
-Increased urination
-Fatigue
-Loss of appetite
-Nausea and vomiting
-Sensitivity to light or sound
-Sweating

Symptoms may linger, even after the migraine goes away. This is called a migraine hangover. Symptoms can include:

-Feeling mentally dull, like your thinking is not clear or sharp
-Needing more sleep
-Neck pain

Exams and Tests
Your provider can diagnose migraine headache by asking about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a brain disorder.

There is no specific test to prove that your headache is actually a migraine. In most cases, no special tests are needed. Your provider may order a brain CT or MRI scan if you have never had one before. The test may also be ordered if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness.

An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.

Treatment
There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away and to prevent symptoms by avoiding or changing your triggers.

A key step is learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Then you and your provider can plan how to avoid these triggers.

Lifestyle changes include:

-Better sleep habits, such as getting enough sleep and going to bed at the same time each night
-Better eating habits, including not skipping meals and avoiding your food triggers
-Managing stress
-Losing weight, if you're overweight

If you have frequent migraines, your provider may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medicines may include:

-Antidepressants
-Blood pressure medicines, such as beta blockers
-Anti-seizure medicines
-Calcitonin gene-related peptide agents
-Botulinum toxin type A (Botox) injections may also help reduce migraine attacks if they occur more than 15 days a month.

Some people find relief with minerals and vitamins. Check with your provider to see if riboflavin or magnesium is right for you.

TREATING AN ATTACK

Other medicines are taken at the first sign of a migraine attack. Over-the-counter (OTC) pain medicines, such as acetaminophen, ibuprofen, or aspirin are often helpful when your migraine is mild. Be aware that:

Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
Taking too much acetaminophen can damage your liver.
Too much ibuprofen or aspirin can irritate your stomach or kidneys.
If these treatments do not help, ask your provider about prescription medicines. These include nasal sprays, suppositories, or injections. The group of medicines most often used is called triptans.

Some migraine medicines narrow the blood vessels. If you are at risk for having a heart attack or have heart disease, talk with your provider before using these medicines. Some migraine medicines should not be used by pregnant women. Talk with your provider about which medicine is right for you if you are pregnant or planning to become pregnant.

Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with the other drugs that treat the migraine itself.

PREVENTING MIGRAINE HEADACHES

If your migraines occur more than twice a week despite the use of triptans, your provider may place you on medicines to take every day, which may help prevent your migraines. The goal is to prevent how often migraines occur and how severe the headache is. 

Outlook (Prognosis)
Each person responds differently to treatment. Some people have migraines only rarely and need little to no treatment. Others need to take several medicines or even go to the hospital sometimes.

Migraine headache is a risk factor for stroke. Risk is higher in people who smoke, more so in women who have migraines that occur with aura. In addition to not smoking, people with migraines should avoid other risk factors for stroke. These include:

-Taking birth control pills
-Eating unhealthy foods, which can cause high cholesterol or high blood pressure

When to Contact a Medical Professional

Call 911 or the local emergency number if:

-You are experiencing "the worst headache of your life."
-You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before.
-A headache starts suddenly.

Schedule an IN-PERSON visit with your medical provider if:

-Your headache pattern or pain changes.
-Treatments that once worked no longer help.
-You have side effects from your medicine.
-You are taking birth control pills and have migraine headaches.
-Your headaches are more severe when lying down.
[/conditional]

[conditional field="typevisit" condition="(typevisit).is('URINARY TRACT INFECTION')"][select name="uti" value="URINARY TRACT INFECTION NEXT STEPS
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Thanks for using our Lemonaid health web service. Hope you feel better soon.

Wait 1 hour before calling the pharmacy and letting them know how you will pay (cash or insurance) and when it will be ready to be picked up. Be sure to pick up the medicine right away so you can start feeling better sooner.

Read the important TREATMENT PLAN included in my prior message.

Some helpful UTI tips:

-ALWAYS urinate after sex!
-Drink plenty of water-more than you normally would and then some.
-You can try to put 100% cranberry juice in your water daily or at least if you know you are going to have sex.
-Taking a probiotic on an EMPTY stomach, 2-4 HOURS before/after taking the antibiotic will help maintain your good gut flora.
-DO NOT wait too long (more than 3 days) to seek treatment for a UTI to prevent a more serious infection.|RECURRING URINARY TRACT INFECTION NEXT STEPS
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Sorry you aren't feeling well.

Because you had a urinary tract infection (UTI) or bladder infection within the past 3 months, please do the following:

Please get your medicine today and start right away.

If you do NOT feel improved after 3 full days of antibiotics (6 pills) see a health care provider in person for urine culture / evaluation

if you DO FEEL improved, finish all of your antibiotics.

Also having a UTI so quickly after a previous treatment can be due to the following risk factors:

-if you have used spermicide in the past year
-having a new sex partner in the past year
-having had your first bladder infection at or before age 15
-having a mother with a history of bladder infection
-if you have anal to vaginal sex

Frequent use of antibiotics to treat urinary tract infections can lead to resistant strains of bacteria.

BE SURE to Urinate right after sex to decrease chance of UTI Wipe from front to back after using the toilet (vagina to rectrum) Avoid anal to vaginal sex

FOR THE FUTURE, if you feel mild bladder infection symptoms coming back, increase your fluid intake and wait 24 hours to see if symptoms get better. If symptoms do not improve after 24 hours, see us or your health care provider in person.

If you have any questions, please let us know. Hope you feel better soon."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('ASTHMA')"]
ASTHMA
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Great chatting with you on video!

as we discussed:

your ideal peak flow should be between: [text name="pf1" default=""] to [text name="pf2" default=""].

This is considered the GREEN ZONE. Your asthma is well controlled.

If your peak flow number is between 60 to 80% of the above number, that is the YELLOW ZONE. You should may need to use your rescue inhaler more often. You may need to adjust your preventive inhaler so that your numbers are back in the GREEN ZONE. If you are NOT sure how to adjust your preventive inhaler, please ask your primary care provider.

If your peak flow number is less than 60% of the above number, that is the RED ZONE. You should use your rescue inhaler, adjust your preventive inhaler and seek medical care as soon as you can!

Ideally when your asthma is under good control, you should not need albuterol (rescue inhaler) more than once a week.

ask the pharmacist about getting or go to amazon.com and find:

a SPACER for your inhaler. it effectively doubles the amount of medicine in your lungs which each puff.

a PEAK FLOW METER to measure your lung capacity. let me know what your number is.

Questions, please let me know.

[checkbox name="asthmagerd" value="HEARTBURN AND ASTHMA
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If your heartburn is NOT well controlled, that can sometimes be the cause of asthma flare-ups.

Check out our ACID REFLUX service if you need prescription medicine can help you."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('INSOMNIA')"]
[checkbox name="adhd" value="ADHD HISTORY
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Medicines used to treat ADHD act as stimulants and can often lead to sleep problems. Talk to the health care provider managing your ADHD if you believe your insomnia and problem with sleep is related to use of ADHD medicine. It's also important to review and practice the sleep hygiene techniques that have been provided to you in your account and Treatment Plan."]

[checkbox name="otc" value="OVER THE COUNTER SLEEP AIDS
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We recommend that you stop all over the counter sleep medications while we are treating your insomnia as over the counter sleep medication may cause dangerous sedation when taken with the sleep medication we are prescribing."][/conditional]

[conditional field="typevisit" condition="(typevisit).is('PRIMARY CARE VISIT')"]

[select name="pcedu" value="ACUTE BRONCHITIS
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Acute bronchitis is swelling and inflamed tissue in the main passages that carry air to the lungs. This swelling narrows the airways, which makes it harder to breathe. Other symptoms of bronchitis are a cough and coughing up mucus. Acute means the symptoms have been present only for a short time.

Causes
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When acute bronchitis occurs, it almost always comes after having a cold or flu-like illness. The bronchitis infection is caused by a virus. At first, it affects your nose, sinuses, and throat. Then it spreads to the airways that lead to your lungs.
Sometimes, bacteria also infect your airways. This is more common in people with COPD. Chronic bronchitis is a long-term condition. To be diagnosed with chronic bronchitis, you must have a cough with mucus on most days for at least 3 months.

Symptoms
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Some symptoms of acute bronchitis are:
* Chest discomfort
* Cough that produces mucus, the mucus may be clear or yellow-green
* Fatigue
* Fever, usually low-grade
* Shortness of breath that gets worse with activity
* Wheezing, in people with asthma

Even after acute bronchitis has cleared, you may have a dry, nagging cough that lasts for 1 to 4 weeks.

Sometimes it can be hard to know if you have pneumonia or bronchitis. If you have pneumonia, you are more likely to have a high fever and chills, feel sicker, or feel more short of breath.

Exams and Tests
******************************************************
Your health care provider will listen to the breathing sounds in your lungs with a stethoscope. Your breathing may sound abnormal or rough.
Tests may include:
* Chest xray, if your provider suspects pneumonia
* Pulse oximetry, a painless test that helps determine the amount of oxygen in your blood by using a device placed on the end of your finger

Treatment
******************************************************
Most people DO NOT need antibiotics for acute bronchitis caused by a virus. The infection will almost always go away on its own within 1 week. Doing these things may help you feel better:
* Drink plenty of fluids.
* If you have asthma or another chronic lung condition, use your inhaler.
* Get plenty of rest.
* Take aspirin or acetaminophen if you have a fever. DO NOT give aspirin to children.
* Breathe moist air by using a humidifier or steaming up the bathroom.

Certain medicines that you can buy without a prescription can help break up or loosen mucus. Look for the word guaifenesin on the label. Ask the pharmacist for help finding it.

If your symptoms do not improve or if you are wheezing, your provider may prescribe an inhaler to open your airways.

If your provider thinks you also have bacteria in your airways, they may prescribe antibiotics. This medicine will only get rid of bacteria, not viruses.
Your provider may also prescribe corticosteroid medicine to reduce swelling in your lungs.

If you have the flu and it is caught in the first 48 hours after getting sick, your provider might also prescribe antiviral medicine.

Other tips include:
******************************************************
* DO NOT smoke.
* Avoid secondhand smoke and air pollution.
* Wash your hands (and your children's hands) often to avoid spreading viruses and other germs.

Outlook (Prognosis)
******************************************************
Except for the cough, symptoms usually go away in 7 to 10 days if you do not have a lung disorder. Coughing often lasts for 2 to 3 weeks.

When to Contact a Medical Professional
******************************************************
Contact your provider if you:
* Have a cough on most days, or have a cough that keeps returning
* Are coughing up blood
* Have a high fever or shaking chills
* Have a low-grade fever for 3 or more days
* Have thick, yellow-green mucus, especially if it has a bad smell
* Feel short of breath or have chest pain
* Have a chronic illness, like heart or lung disease

|CONJUNCTIVITIS
******************************************************
The conjunctiva is a clear layer of tissue lining the eyelids and covering the white of the eye. Conjunctivitis occurs when the conjunctiva becomes swollen or inflamed.

This swelling can be due to an infection, an irritant, dry eyes, or an allergy.

Causes
******************************************************
Tears most often protect the eyes by washing away the germs and irritants. Tears contain proteins and antibodies that kill germs. If your eyes are dry, germs and irritants are more likely to cause problems.

Conjunctivitis is most often caused by germs such as viruses and bacteria.

*Pink eye most often refers to a highly contagious viral infection that spreads easily among children.
* Conjunctivitis can be found in people with COVID-19 before they have other typical symptoms.
* In newborns, an eye infection may be caused by bacteria in the birth canal. This must be treated at once to preserve eyesight.
* Allergic conjunctivitis occurs when the conjunctiva becomes inflamed due to a reaction to pollen, dander, mold, or other allergy-causing substances.
A type of long-term allergic conjunctivitis may occur in people who have chronic allergies or asthma. This condition is called vernal conjunctivitis. It most commonly occurs in young men and boys in the spring and summer months. A similar condition can occur in long-time contact lens wearers. It may make it difficult to continue to wear contact lenses.
Anything which irritates the eye may cause conjunctivitis also. These include:
* Chemicals.
* Smoke.
* Dust.
* Over-use of contact lenses (often extended-wear lenses) can lead to conjunctivitis.

Symptoms
******************************************************
Symptoms include:
* Blurred vision
* Crusts that form on the eyelid overnight (most often caused by bacteria)
* Eye pain
* Gritty feeling in the eyes
* Increased tearing
* Itching of the eye
* Redness in the eyes
* Sensitivity to light

Exams and Tests
******************************************************
Your health care provider will:
* Examine your eyes
* Swab the conjunctiva to get a sample for analysis
There are tests that can sometimes be done in the office to look for a specific type of virus as the cause.

Treatment
******************************************************
Treatment of conjunctivitis depends on the cause.
Allergic conjunctivitis may improve when allergies are treated. It may go away on its own when you avoid your allergy triggers. Cool compresses may help soothe allergic conjunctivitis. Eye drops in the form of antihistamines for the eye or drops containing steroids, may be necessary in more severe cases.

Antibiotic medicines work well to treat conjunctivitis caused by bacteria. These are most often given in the form of eye drops. Viral conjunctivitis will go away on its own without antibiotics. Mild steroid eye drops may help ease discomfort.

If your eyes are dry, if may help to use artificial tears in conjunction with any other drops you may be using. Be sure to allow about 10 minutes in between using different types of eye drops. Crustiness of the eyelids can be helped by applying warm compresses. Gently press clean cloth soaked in warm water to your closed eyes.

Other helpful steps include:
* DO NOT smoke and avoid secondhand smoke, direct wind, and air conditioning.
* Use a humidifier, especially in the winter.
* Limit medicines that may dry you out and worsen your symptoms.
* Clean eyelashes regularly and apply warm compresses.

Outlook (Prognosis)
******************************************************
The outcome for bacterial infections is most often good with early antibiotic treatment. Pinkeye (viral conjunctivitis) can easily spread through entire households or classrooms.

When to Contact a Medical Professional
******************************************************
Contact your provider if:
* Your symptoms last longer than 3 or 4 days.
* Your vision is affected.
* You have light sensitivity.
* You develop eye pain that is severe or becoming worse.
* Your eyelids or the skin around your eyes becomes swollen or red.
* You have a headache in addition to your other symptom.

Prevention
******************************************************
Good hygiene can help prevent the spread of conjunctivitis. Things you can do include:
* Change pillowcases often.
* DO NOT share eye makeup and replace it regularly.
* DO NOT share towels or handkerchiefs.
* Handle and clean contact lenses properly.
* Keep hands away from the eye.
* Wash your hands often."] [/conditional]

[checkbox name="etoh" value="ALCOHOL USE
******************************************************
If you drink alcohol, we recommend:

women do NOT drink more than 1 servings of alcohol per day. 

men do NOT drink more than 2 servings of alcohol per day.

If you are unable to cut down or quit, we recommend you see a health care provider in person for additional help."] [select name="etohreason" value="|Drinking more than recommended can impact your overall health.|Drinking more than recommended can impact our treatment for depression or anxiety.|Drinking more than recommended can impact our treatment for erectile dysfunction.|Drinking more than recommended can impact your sleep quality."]

[checkbox name="thc" value="MARIJUANA USE
******************************************************
MARIJUANA If you use marijuana, we recommend you stop completely. If you are unable to cut down or quit, we recommend you see a health care provider in person for additional help."] [select name="thcreason" value="|We recommend you quit for your overall health.|We recommend you quit to ensure your treatment for depression or anxiety is successful.|We recommend you quit to ensure your treatment for insomnia is successful."]

[checkbox name="da" value="DEPRESSION / ANXIETY?
******************************************************
As an online health care provider's office, we want to help you get the care you need for both your physical and mental health.

I see that you reported several days symptoms of depression and/or anxiety. If these are problems that you've had for a while and are impacting work or home life, please use our FREE mental health assessment - https://tinyurl.com/y5omdwau to gain a better understanding of your symptoms and treatment options"]

[comment memo="Nicotine Use"]
[select name="nicotine" value="|SMOKING
******************************************************
I see that you smoke. I do recommend that you quit. If you’ve quit in the past, good job!  We do have a STOP SMOKING service if you’re interested. The prescription medicines bupropion (Zyban) or varenicline (Chantix) can double your chances of stopping smoking.

On average it can take up to 5 times to quit before you’re successful and quit for good, so don't give up! Quitting smoking not only decreases your risk of preventable and premature heart attack and stroke. Check out www.smokefree.gov.|VAPING
******************************************************

E-cigarettes are still fairly new, and scientists are still learning about their long-term health effects. Here is what we know now.

Most e-cigarettes contain nicotine, which has known health effects.

Nicotine is highly addictive.
Nicotine is toxic to developing fetuses.
Nicotine can harm adolescent and young adult brain development, which continues into the early to mid-20s.
Nicotine is a health danger for pregnant adults and their developing babies.

Besides nicotine, e-cigarette aerosol can contain substances that harm the body.

This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.
 
E-cigarettes can cause unintended injuries.

Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions happened when the e-cigarette batteries were being charged.
The Food and Drug Administration (FDA) collects data to help address this issue. You can report an e-cigarette explosion, or any other unexpected health or safety issue with an e-cigarette at https://www.fda.gov/tobacco-products/products-ingredients-components/tips-help-avoid-vape-battery-or-fire-explosions#red
.
In addition, acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.

We recommend decreasing or quitting vaping for your overall health and wellness. You can read more information about vaping at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/|SMOKELESS TOBACCO
******************************************************

The use of any tobacco product has immediate and long-term effects on your health and overall well-being. Smokeless tobacco stains and wears down your teeth, causes your gums to recede (peel back) and produces mouth sores. Bad breath is a common problem. Over time, the use of smokeless tobacco can cause mouth cancer. Nicotine from smokeless tobacco also raises blood pressure and cholesterol levels, and can make it more likely that you will have a heart attack.

It is important for you to have your own reasons for wanting to stop using smokeless tobacco. In addition to health effects, you may be concerned about saving money, giving up an addictive habit or setting a good example for family members and friends. Write down your reasons for wanting to quit using smokeless tobacco. Then keep your list in places where you can see it often while you try to stop.

For more information on how to quit using smokeless tobacco, visit https://www.aafp.org/pubs/afp/issues/2000/0915/p1423.html"]

ADDITIONAL SERVICES OFFERED THROUGH LEMONAID
******************************************************
As a reminder, we offer many popular services, with the convenience of medicine mailed quickly to the home.

We can treat both men and women with cold sores, genital herpes, depression / anxiety, quit smoking, and cholesterol statin treatment. 

For men we also treat erectile dysfunction and hair loss; and for women we offer a wide range of birth control choices and urine screening for chlamydia / gonorrhea (STD) via Quest Diagnostics lab.

Please do not hesitate to reach out with any additional questions.

As always, if you have additional questions or need additional assistance, you may message us through your Lemonaid account or reach out to our patient support team at 888-536-2267.

Office Hours EAST COAST:

Monday to Friday open 7:00 AM - 8:00 PM (EST)
Saturday/Sunday open 8:00 AM - 7:00 PM (EST)

Office Hours WEST COAST:

Monday to Friday open 4:00 AM - 5:00 PM (PST)
Saturday/Sunday open 5:00 AM - 4:00 PM (PST)

Joshua Reed, NP





SUMMARY OF VISIT
******************************************************
Thanks for the opportunity to care for you. Here are some of the highlights from our visit:

.

A prescription has been sent to . Please make sure to read all information sent in your treatment plan and do not hesitate to reach out with any questions or concerns.



























Nicotine Use


ADDITIONAL SERVICES OFFERED THROUGH LEMONAID
******************************************************
As a reminder, we offer many popular services, with the convenience of medicine mailed quickly to the home.

We can treat both men and women with cold sores, genital herpes, depression / anxiety, quit smoking, and cholesterol statin treatment.

For men we also treat erectile dysfunction and hair loss; and for women we offer a wide range of birth control choices and urine screening for chlamydia / gonorrhea (STD) via Quest Diagnostics lab.

Please do not hesitate to reach out with any additional questions.

As always, if you have additional questions or need additional assistance, you may message us through your Lemonaid account or reach out to our patient support team at 888-536-2267.

Office Hours EAST COAST:

Monday to Friday open 7:00 AM - 8:00 PM (EST)
Saturday/Sunday open 8:00 AM - 7:00 PM (EST)

Office Hours WEST COAST:

Monday to Friday open 4:00 AM - 5:00 PM (PST)
Saturday/Sunday open 5:00 AM - 4:00 PM (PST)

Joshua Reed, NP



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