Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-04-28 Encounter: Spruce text message followed by in-person office visit (4/30) CC: Headache, subjective fever, and persistent cough; parent requesting strep test due to prior history of strep. HPI: Nelly stayed home from school on 4/28 with a headache and subjective warmth (temp 99.8°F after two doses of Tylenol that day). She had a persistent cough from the prior illness episode beginning approximately 4/23. She had no sore throat at the time of the message. Parent noted this presentation was similar to prior episodes when she tested positive for strep. On 4/29 she was sent home from school with a temp of 101.2°F. On 5/3, a home flu test (performed at grandmother's house, who is a nurse) was positive for Influenza B; she had been lethargic and warm at dance on 5/3. Assessment: Temperature of 99.8°F not considered elevated after Tylenol. Throat photo reviewed on 4/28 — not significantly red. Strep less favored. After a home Influenza B positive test on 5/3, Dr. Hobbs assessed that the positive flu B result made more sense with her overall symptom picture but did not believe she currently had active flu B at that time, as symptoms had been going on too long for flu testing to be meaningful when he saw her. False positive rate for strep noted at approximately 15% this time of year. Plan: Dr. Hobbs reviewed throat photos on 4/28 and reassured parent. Scheduled in-person office visit for 4/30. After in-person visit, she returned to school. On 4/30, parent also reported abdominal pain that worsened with movement; Dr. Hobbs advised monitoring. On 5/3, after positive home flu B test, Dr. Hobbs recommended rest and monitoring for worsening cough, breathing difficulty, or fever spike. Medications: - Tylenol Twice on 4/28 (dose not specified) (new) Key clinical quotes: "Great. No elevated temp." "Flu b makes more sense for the symptoms she was having. False positive rate on strep this time of year is about 15%." "I do not think she NOW has flu b. When I saw her she had symptoms for too long to make testing her for flu worth it" "Rest as long as her cough or breathing aren't too bad or if her fever spikes back up" Source: Spruce conversation t_27C02FVS44O00