ack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees
cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes
mellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive
pulmonary disease issues from a 30-pack year history of smoking. His last visit with you was
over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill
of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the
electronic links to the cardiology service within your facility, the medication was due to be
renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic
panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last
recorded 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 pulmonary
issues. 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 respirations
22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse
oximetry was 92% on room air.