ack is a 54-year-old patient who has difficulty coming in for primary care visits. He seescardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetesmellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructivepulmonary disease issues from a 30-pack year history of smoking. His last visit with you wasover a year ago. Today, your registered nurse brings you a telephone triage call requesting a refillof his Crestor prescription, which was ordered by cardiology soon after his CABG. Per theelectronic links to the cardiology service within your facility, the medication was due to berenewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolicpanel (CMP) was done at the same time. He was recently at the pulmonary clinic and his lastrecorded HgA1C was 9.0 from a visit to endocrine 4 months ago.Review of records include a prescription for his hypertension (Lisinopril 20 mg daily),metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonaryissues. The Crestor prescription appears to have multiple dosing levels over the past few refills.His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations22. His body mass index is 30 and he indicates a pain level of four out of five. His pulseoximetry was 92% on room air.1.
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