PCOS Consult

OVERALL_INSTRUCTIONS

Chief Complaint

rc-upload-1774647356768-36.docx

Template

Thank you for referring [Patient Name], a [Age] year old women, who was seen on [Date] for assessment of PCOS. Consent: I obtained consent from the patient for use of an AI scribe software. I explained that [Software Name] saves a copy of our conversation on their website for the purpose of generating a note, and that this software is FDA approved. History of Presenting Illness: Menstrual history: [Menstrual History — if not provided, default to "No abnormalities reported"] Acne: [Acne History — if not provided, default to "No significant acne reported"] Excess hair growth: [Excess Hair Growth — if not provided, default to "No significant hirsutism reported"] Weight: [Weight History — if not provided, default to "Stable weight reported"] Virilization symptoms: [Virilization Symptoms — if not provided, default to "No virilization symptoms such as male pattern baldness, voice deepening, increased musculature, or clitoromegaly"] Past medical history: [Relevant Medical History] Other medications: [Current Medications] Allergies: [Allergies] Social history: Work: [Occupation] Extended coverage: [Insurance Coverage] Alcohol: [Alcohol Use] Cigarettes: [Cigarette Use] Drugs: [Drug Use] Family history: [Family History] Exam: [Physical Exam Findings — if not provided, default to "Unremarkable physical exam"] Investigations: [Relevant Investigations — if not provided, default to "No investigations available"] Impression and Plan: 1. [Primary Diagnosis]: - Treatment options include [Treatment Options]. The patient has decided [Patient Decision]. - Additional management includes [Management Plan]. - I have provided a bloodwork requisition to assess for [Purpose of Bloodwork], including: [List of Tests]. - I have provided a requisition for [Imaging/Other Tests]. For example 1. PCOS - Treatment for clinical hyperandrogenism include OCP, weight loss, metformin, spironolactone, and cyproterone acetate. 2. Oligomenorrhea: likely due to PCOS, and I will exclude other diagnoses, including Cushing's syndrome, acromegaly, non-classic congenital adrenal hyperplasia, thyroid disorders, hyperprolactinemia, ovarian hyperthecosis, and rarely androgen secreting tumors. (List detailed action plans using the correct person tone, e.g., 'I have started dapagliflozin for diabetes control' or 'The family doctor has initiated...) - Treatment for clinical hyperandrogenism include: 1) OCP, 2) weight loss, 3) metformin, 4) spironolactone (contraindicated in pregnancy and breastfeeding), 5) cyproterone acetate (on days 1-10 of cycle in combination with OCP or continuous, needs 4 months washout prior to conception, monitor liver enzymes q6months), 6) Finasteride (teratogenic). The patient has decided to initiate - Treatment for oligomenorrhea is through a combination of weight loss and OCP. Diane 35 includes cyproterone acetate, and is indicated for severe acne. - OCP options: - I have provided a bloodwork requisition to be done on day 3 of her menses, to assess for biochemical hyperandrogenism and to evaluate for secondary causes of PCOS, including: testosterone, SHBG, bioavailable testosterone, DHEAS, androstenedione, estrogen, progesterone, prolactin, 17-OHP, AM cortisol, TSH, IGF1, 1mg dexamethasone suppression test, and A1c (vs 75g OGTT) - I have provided a requisition for ovarian US - I have recommended a menstrual period at least once every 3 months, and this can be done with OCP or progesterone (prometrium 200mg qhs daily x12 days or medroxyprogesterone acetate 10mg daily for 10 days) Counselling: I have counselled the patient on the risks and benefits of the prescribed medications, including potential teratogenic effects and the need to use reliable birth control. Sincerely, [Your Name], [Your Credentials]