Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2025-09-22 Encounter: Spruce text message CC: Cough all night, now with signs of respiratory distress including rib pulling, belly breathing, and wheeze; out of albuterol. HPI: Malcolm, age 5, had a cough that started the prior day and kept him up all night. By morning he was showing signs of increased work of breathing including rib pulling, belly breathing, and wheeze. His temperature was approximately 99°F. Albuterol supply was completely depleted. The AI triage system (Clara) recommended immediate ER evaluation given the distress signs. Dr. Hobbs had already sent a prescription to CVS Excelsior at approximately 6 AM. Assessment: Acute bronchospasm/reactive airway exacerbation with signs of increased work of breathing. Prescription sent proactively before parent follow-up. Albuterol inhaler dispensed by pharmacy; nebulizer solution additionally prescribed. Plan: Albuterol inhaler already sent to CVS Excelsior (~6 AM). Additional albuterol nebulizer solution prescription sent upon parent's request. Parent to use spacer with inhaler; nebulizer solution provided as well. Medications: - Albuterol inhaler (prescription sent to CVS Excelsior) (new) - Albuterol nebulizer solution (additional prescription sent) (new) Key clinical quotes: "Yep. Sent it to cvs on excelsior" "And you can have both! I'll send they too" Source: Spruce conversation t_27C02FVS44O00