Patient Note — 158451

progress_notes_158451_1_deid.txt

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Demographics & Encounter

Patient ID158451 (PHI redacted)
Age / Gender57 / Male
Date of Service2026-03-30
ProviderNone
FacilityTELE-POTOMAC UROLOGY CENTER-WB
PayerUHC
Reason1. FOLLOW UP REV LABS

Diagnoses

E34.9 Testosterone deficiency
R31.0 Gross hematuria
N39.0 Recurrent UTI
Z80.42 Family history of malignant neoplasm of prostate

Clinical Summary (HPI)

Low Testosterone: 57yM w/ hx of low testosterone and liver transplant in 2023 presents via TV for f/u to review labs. The patient was previously on testosterone gel; however, following his liver transplant, he discontinued this therapy. He notes significant fatigue throughout the day and erectile dysfunction. He is interested in restarting the therapy. -------------- The patient's previous workup history is listed below: Testosterone: 234 (03/19/2026); 235 (03/12/2026) HCT: 42.7 (03/19/2026); 42.8 (03/12/2026) Hepatic: 154 (03/19/2026); 159 (03/12/2026) PSA: 1.2 (03/19/2026); 1.1 (03/12/2026); 2.33 (January 2025). UTI: Also, w/ hx of recurrent UTIs and gross hematuria. The patient reports no recent UTIs or GH. - - - - - - - - - - - - - - The patient's previous work-up history is listed below: Cysto: Normal (May 2025) RBUS: Mild diffuse bladder wall thickening could be seen with cystitis and / or chronic bladder outlet obstruction. Minimal residual postvoid bladder volume. Mild prostatomegaly statistically likely represent benign prostatic hyperplasia (BPH), nonspecific. (02/14/2025). BPH screening: Urocuff information Date 03/18/2025 Peak flow (mL/s) 26.5 Volume voided (cc) 252 Bladder pressure (cm H2O) 200 PVR (mL) 36 Category high pressure/high flow IPSS Questionnaire Date 01/02/2025 IPSS Total 2 Progress Note: [PROVIDER_NAME], PA 03/30/2026 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) Generated for Printing/Faxing/eTransmitting on: 04/08/2026 0

Raw Note (de-identified preview)

4/8/26, 3:57 PM Print Preview [PATIENT_NAME] DOB: [DOB] (57 yo M) Acc No. [ACCOUNT_ID] DOS: 03/30/2026 [PATIENT_NAME] 57 Y old Male, DOB: [DOB] Account: [ACCOUNT_ID]: [PHONE] [ADDRESS] Home: [PHONE] Guarantor: [GUARANTOR_NAME] Insurance: UHC PCP: [PROVIDER_NAME] Referring: [PROVIDER_NAME] Appointment Facility: TELE-POTOMAC UROLOGY CENTER-WB Structured Data: How did you hear about us? : Google; Patient's temperature : 96.8; : 06/28/2022 03/30/2026 TV-F/U : Kevin Reid, PA Reason for Appointment 1. FOLLOW UP REV LABS History of Present Illness Low Testosterone: 57yM w/ hx of low testosterone and liver transplant in 2023 presents via TV for f/u to review labs. The patient was previously on testosterone gel; however, following his liver transplant, he discontinued this therapy. He notes significant fatigue throughout the day and erectile dysfunction. He is interested in restarting the therapy. -------------- The patient's previous workup history is listed below: Testosterone: 234 (03/19/2026); 235 (03/12/2026) HCT: 42.7 (03/19/2026); 42.8 (03/12/2026) Hepatic: 154 (03/19/2026); 159 (03/12/2026) PSA: 1.2 (03/19/2026); 1.1 (03/12/2026); 2.33 (January 2025). UTI: Also, w/ hx of recurrent UTIs and gross hematuria. The patient reports no recent UTIs or GH. - - - - - - - - - - - - - - The patient's previous work-up history is listed below: Cysto: Normal (May 2025) RBUS: Mild diffuse bladder wall thickening could be seen with cystitis and / or chronic bladder outlet obstruction. Minimal residual postvoid bladder volume. Mild prostatomegaly statistically likely represent benign prostatic hyperplasia (BPH), nonspecific. (02/14/2025). BPH screening: Urocuff information Date 03/18/2025 Peak flow (mL/s) 26.5 Volume voided (cc) 252 Bladder pressure (cm H2O) 200 PVR (mL) 36 Category high pressure/high flow IPSS Questionnaire Date 01/02/2025 IPSS Total 2 Progress Note: [PROVIDER_NAME], PA 03/30/2026 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) Generated for Printing/Faxing/eTransmitting on: 04/08/2026 06:27 AM EDT 1/5 4/8/26, 3:57 PM Print Preview [PATIENT_NAME] DOB: [DOB] (57 yo M) Acc No. [ACCOUNT_ID] DOS: 03/30/2026 nocturia score 2 QoL/bother score 1 Current Medications Taking Tacrolimus 0.5 MG Capsule Oral Carvedilol 25 MG Tablet Oral amLODIPine Besylate 5 MG Tablet TAKE 1 TABLET BY MOUTH EVERY DAY Oral Ursodiol 300 MG Capsule Oral Magnesium Oxide Levothyroxine Sodium 75 MCG Tablet Oral Lokelma(Sodium Zirconium Cyclosilicate) 10 GM Packet Oral valACYclovir HCl 500 MG Tablet 1 TAB BY MOUTH EVERY DAY Oral Not-Taking Atorvastatin Calcium 20 MG Tablet 1 tab(s) orally once a day hydrALAZINE HCl 25 MG Tablet 1 tab(s) orally once Atenolol 100 MG Tablet 1 tab(s) orally once a day NIFEdipine ER 30 MG Tablet Extended Release 24 Hour 1 cap(s) orally once a day Allopurinol 100 MG Tablet 1 tab(s) once a day Testosterone 50 MG/5GM (1%) Gel as directed applied topically once a day (in the morning) Screening Vital Signs Past Orders Lab:Prostate-Sp