Patient Note — 244402

4/23/26, 6:44 AM Print Preview [PATIENT_NAME] DOB: [DOB] (73 yo F) Acc No. [ACCOUNT_ID] DOS: 03/10/2026 Annual Visit Patient: [PATIENT_NAME] Provider: [PROVIDER_NAME], MD Account: [ACCOUNT_ID] DOB: [DOB] Age: 73 Y Sex: Female Date: 03/10/2026 Phone: [PHONE] Address: [ADDRESS], BURKE, VA-[ZIP] Pcp: [PROVIDER_NAME] Subjective: Chief Complaints: 1. ANNUAL EXAM. HPI: General Urology: 73-year-old female, former [PROVIDER_NAME] pt, with history of kidney stones is here today to annual exam. Kidney Stones: - - - - - - - - - - - - - - The patient's previous work-up history is listed below: KUB (05/2025): 0.6 cm L renal stone, 0.7 cm calcification projecting over L pelvis reflecting a L ureteral stone. US Renal Complete (12/05/24 @ Fairfax Radiology): 8mm and 7mm lower pole stones. KUB 06/2024 shows left 5mm renal stone, stable in size Has had right URS/LL in past No renal colic, gross hematuria. She does have right sided pain but may be MSK. ROS: 12 system Review of Systems completed in the chart and all pertinent positives and negatives reviewed with the patient cdw. Medical History: High Blood Pressure, High Cholesterol, Diabetes Mellitus. Surgical History: appendectomy , spine surgery . Family History: Father: deceased. Mother: deceased. Screening: Social History: Smoking: no . Recreational drug use: no. Exercise: yes. Caffeine: yes. Alcohol: socially . Occupation: no, Retired. Medications: Taking amLODIPine-Atorvastatin 5-20 MG Tablet 1 tablet Orally Once a day , Taking Atorvastatin Calcium 20 MG Tablet 1 tablet Orally Once a day , Taking metFORMIN HCl 1000 MG Tablet 1 tablet with a meal Orally Once a day , Medication List reviewed and reconciled with the patient Allergies: N.K.D.A. Objective: Vitals: Provider: [PROVIDER_NAME], MD Date: 03/10/2026 Generated for Printing/Faxing/eTransmitting on: 04/23/2026 09:44 AM EDT 1/3 4/23/26, 6:44 AM Print Preview [PATIENT_NAME] DOB: [DOB] (73 yo F) Acc No. [ACCOUNT_ID] DOS: 03/10/2026 RR: 16, HR: Not Taken - Collection Device Broken, BP: Not Taken - Collection Device Broken, Ht: 63, Wt: 129 lbs, BMI: 22.85 Index. Assessment: Assessment: 1. Kidney stones - N20.0 (Primary) 2. Flank pain - R10.9 Plan: Treatment: 1. Kidney stones Imaging: CT Kidney Stone Protocol -Abdomen/Pelvis w/o Contrast (Low Dose) Notes: US Renal Complete (12/05/24 @ Fairfax Radiology): 1. Bilateral nonobstructing renal calculi. Prior x-ray showed only 1 left lower pole stone, now there are 2. 7 and 8 mm on Left kidney. KUB (05/2025): 0.6 cm L renal stone, 0.7 cm calcification projecting over L pelvis reflecting a L ureteral stone. I have reviewed the images and made an independent assessment. Treatment options discussed include: -Observation: the patient is asymptomatic and we will monitor the stone size and rate of increase with serial imaging. -ESWL - The patient was informed regarding greater stone-free rates with stones in the upper/mid pole of the kidney and proximal ureter and lower stone rates in the lower pole. Potential complication