Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-03-22 Encounter: Spruce text message CC: 8-month-old with persistent fever ranging 101–102.5°F since Friday afternoon, with no clear source. HPI: Daisy is an 8-month-old female who developed a fever starting Friday afternoon (approximately 2026-03-20), fluctuating between 101–102.5°F over several days. She has no cough or runny nose, but has had mucousy/runny stools and increased drooling, with teething suspected as a contributing factor. Parents have been managing symptoms with alternating Tylenol and Motrin with good response. She appeared more irritable when off medications but was still eating and had no signs of urinary symptoms. Assessment: Dr. Hobbs assessed the fever as likely viral in etiology, with roseola identified as a strong differential given the fever pattern and subsequent development of a rash on 2026-03-24. UTI was raised as a consideration given the patient's age and sex, though the urgent care visit the following day supported a viral assessment. The rash appearance on 2026-03-24 was assessed as almost certainly roseola. Plan: Parent advised to monitor temperature and return with updates; threshold for concern set at >104°F or signs of lethargy/extreme irritability. UTI flagged as a differential to watch for (foul-smelling urine, persistent or worsening fever). Parent was instructed to reassess on 2026-03-23 and again on 2026-03-24. When rash appeared on 2026-03-24, Dr. Hobbs confirmed roseola diagnosis, advised no treatment needed, and confirmed Daisy was no longer contagious at that stage. No prescription was sent. Medications: - Acetaminophen (Tylenol) Dose not specified; already in use by parent (ongoing home use) - Ibuprofen (Motrin) Dose not specified; already in use by parent (ongoing home use) Key clinical quotes: "Over 104 is for sure a temp to worry about and any temp when she feels over lethargic or irritable" "with girls we have to keep urinary tract infections on our radar too" "Always! Roseola can do this too!" "Almost certainly" Source: Spruce conversation t_2MBH50I4LS000