
ED Provider Notes by JOSE DANIEL ROSA BONILLA MD at 8/22/2026 12:02 AM
ED sign out note 
 
Received sign out from Dr. Sloss
 
HPI: 
Mr. Xuan Wei is a 68 Y male with history of ischemic stroke with Left arm and leg weakness one month ago who presents to the Emergency Department with left arm and leg tingling. 
 
He noticed the tingling around 2 weeks ago.  He has had no weakness in his arms or legs recently. When asked about his stroke he does not remember the symptoms or why he was evaluated. A & O x 4 today. He has persistent peripheral visual field deficits bilaterally since the stroke. No changes in vision. No chest pain, belly pain, headache, n/v, lightheadedness, LOC. He lives at an assisted living home. 
 
Pending 
CTA head and neck. IF there is significant stenosis will need consult with Vascular for potential enderactomy, patient to be Dced after CTA results 
 
1:06 AM
CTA showed significant stenosis of the left internal carotid as well as occluded right common carotid artery with reconstitution distally. E-consult placed with vascular surgery for follow up. Patient Dced per prior plan 
 
Recent Results (from the past 24 hours)
CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)
 
Collection Time: 08/21/26  8:20 PM
Result
Value
Ref Range
 
Estimated Glomerular Filtration Rate
>60
>=60 mL/min/1.73 m2
 
Sodium
138
135 - 145 mEq/L
 
Potassium
4.0
3.5 - 5.3 mEq/L
 
Chloride
107
100 - 111 mEq/L
 
CO2
26
24 - 33 mEq/L
 
Anion gap, ser/plas
5
5 - 16 mEq/L
 
BUN
12
7 - 27 mg/dL
 
GLUCOSE, RANDOM
130
60 - 159 mg/dL
 
Creatinine
0.95
<=1.34 mg/dL
CBC W AUTOMATED DIFFERENTIAL
 
Collection Time: 08/21/26  8:20 PM
Result
Value
Ref Range
 
WBC COUNT
5.1
3.7 - 11.1 K/uL
 
Red blood cells count
4.48
4.10 - 5.70 M/uL
 
Hgb
13.2
13.0 - 17.0 g/dL
 
Hematocrit
39.1
39.0 - 51.0 %
 
MCV
87
80 - 100 fL
 
RDW, RBC
12.2
11.5 - 16.5 %
 
Platelets count
157
140 - 400 K/uL
 
RBC's, nucleated
0
<=0 /100WC
WBC AUTO DIFF
 
Collection Time: 08/21/26  8:20 PM
Result
Value
Ref Range
 
Neutrophils, Automated Count
3.0
1.8 - 7.9 K/uL
 
Lymphocytes, Automated Count
1.6
0.9 - 3.2 K/uL
 
Monocytes, Automated Count
0.4
0.3 - 0.9 K/uL
 
Eosinophils, Automated Count
0.1
0.0 - 0.4 K/uL
 
Basophils, Automated Count
0.0
0.0 - 0.1 K/uL
 
Immature Granulocytes, Automated Count
0.0
0.0 - 0.1 K/uL
 
Neutrophils %, Automated count
59
%
 
Lymphocytes %, Automated count
31
%
 
Monocytes %, Automated Count
8
%
 
Eosinophils %, Automated Count
1
%
 
Basophils %, Automated Count
0
%
 
Immature Granulocytes %, Automated Count
0
%
 
 
 
 
====================   CT ANGIOGRAM
Result Date: 8/22/2026
    CT ANGIOGRAM HEAD AND NECK WITH CONTRAST     ** HISTORY **:  68 years old,  Stroke/TIA, assess intracranial arteries   ** TECHNIQUE **:  CT angiogram images of the head and neck acquired with 94 mL Omnipaque 350 intravenous contrast. Maximum intensity projection (MIP) vessel images were obtained.   CTDI: 0.07,0.55,42.57,24.75 mGy  DLP: 2.99,23.92,21.28,989.87 mGy-cm   COMPARISON: CTs 8/21/2026, 7/18/2026, MRs 7/16/2026, 10/30/2025   ** FINDINGS **:  CTA HEAD: Multifocal intracranial stenosis with moderate bilateral paraclinoid and right supraclinoid internal carotid artery narrowing, mild to moderate left P1/P2 narrowing and mild left P2 narrowing, and mild right P1/P2 narrowing and diffuse irregularity and mild narrowing of the right M1 and mild narrowing in the left distal M1. There is mild bilateral intracranial vertebral artery stenosis.   Recent right temporal occipital lobe infarcts and right thalamus infarcts and chronic left frontal lobe infarcts are again noted.   CTA NECK  GREAT VESSELS: Right common carotid artery is occluded at the origin   RIGHT ICA: The right common carotid artery is occluded at the origin with mild fluid is noted in the right distal common carotid artery with extensive atherosclerotic calcifications Approximately 80% stenosis as measured on series 601, image 21 by NASCET criteria at the carotid bifurcation with extensive atherosclerotic calcified plaques in the right common carotid artery, right carotid bulb and proximal right internal carotid artery and proximal right external carotid artery   LEFT ICA: Approximately 76% stenosis as measured on series 2, image 125 by NASCET criteria at the carotid bifurcation with extensive atherosclerotic calcification in the left common carotid artery and left carotid bulb and proximal left internal and external carotid artery plaque. No dissection.   VERTEBRAL ARTERIES: Patent extracranial segments. No dissection.   OTHER: Diffuse emphysematous changes with bulla. Calcified left hilar granulomas are noted.   Mild degenerative changes are noted.   
 
IMPRESSION:        1.   Occluded right common carotid artery at the origin with   reconstitution of the right distal common carotid artery with extensive atherosclerotic calcifications in the right common carotid artery, right carotid bulb and proximal right internal carotid artery and proximal right external carotid artery with approximately 80% stenosis in the proximal right internal carotid artery.      2.   Approximately 76% stenosis in the proximal left internal carotid artery.  3. Multifocal intracranial stenosis with moderate bilateral paraclinoid and right supraclinoid internal carotid artery narrowing, mild to moderate left P1/P2 narrowing and mild right P1/P2 narrowing and diffuse irregularity and mild narrowing of the right M1 and mild narrowing in the left distal M1.  4. Mild bilateral intracranial vertebral artery stenosis.        Action Required. This report was marked as "high priority" in the referring provider's HealthConnect inbox.   +  #imag1        
 
====================   CT HEAD
Result Date: 8/21/2026
    CT HEAD WITHOUT CONTRAST     ** HISTORY **:  68 years old,  Neuro deficit, acute, stroke suspected 2 weeks of left arm and leg weakness   ** TECHNIQUE **:  CT images of the head acquired without intravenous contrast.   CTDI: 40.54 mGy  DLP: 648.57 mGy-cm   COMPARISON: CTs 7/18/2026, 7/16/2026   ** FINDINGS **:   BRAIN PARENCHYMA: No acute hemorrhage. No mass effect or herniation.   Stable encephalomalacia in the right temporal occipital lobe. Stable foci of encephalomalacia in the left frontal lobe and left occipital lobe. Chronic lacunar infarct in the right internal capsule and right thalamus.   VENTRICLES/EXTRA-AXIAL SPACES: Ventricles remain within normal limits. No extra-axial fluid collection.   EXTRACRANIAL STRUCTURES: Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are clear.   
 
IMPRESSION:         1.   No acute intracranial abnormality.       2. Chronic infarct in the distribution of the right posterior cerebral artery.       3. Chronic infarcts in the left frontal lobe and left occipital lobe and chronic lacunar infarcts in the right internal capsule and right thalamus.        
 
 
JOSE DANIEL ROSA BONILLA MD
 
 
 
 





ED Provider Notes by ROSE-CARMEL ANN GODDARD MD at 8/21/2026  8:05 PM
Attestation signed by DAVID JOSHUA SLOSS MD at 8/21/2026 11:58 PM
Attending Note:  I've interviewed and examined the patient after the resident.  I have performed the key portions of the H&P and agree with the resident's findings. 
 
68 yo male with a history of CVA 1 month ago with left sided weakness presenting with 2 weeks of tingling in his left arm and leg.
 
On exam, NAD.  A&O X 3.  CN II-XII intact.  Finger to nose normal.  Strength normal.  Ambulatory.  Sensation normal.
 
I have supervised the ER course and procedures performed. The resident and I have discussed and formulated the treatment plan. Please refer to the resident note for further details.
 
Impression:  
PARESTHESIA  (primary encounter diagnosis)
 
HX OF ISCHEMIC STROKE
Plan: 14 DAY CONTINUOUS MONITOR CARD, CV
 
Disposition: Sign-out to Dr. Rosa in stable condition.  CTA result pending.  Vascular surgery referral if carotid stenosis present.
 
I have reviewed the clinical diagnoses listed below which were considered in the care of this patient.  At the time of this visit there are no changes in these conditions unless otherwise noted.  The patient will be advised to follow up after discharge with their PCP or appropriate specialist as treatment warrants.  
 
Clinical Diagnoses:  
 
 
CHRONIC HEPATITIS B
 
MEDI-CAL GMC CARE COORDINATION
 
HTN (HYPERTENSION)
 
HYPERLIPIDEMIA
 
GERD (GASTROESOPHAGEAL REFLUX DISEASE)
 
COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)
 
ATHEROSCLEROSIS OF AORTA
 
PERIPHERAL ARTERY DISEASE, UNSPECIFIED TYPE
 
HEMIPLEGIA & HEMIPARESIS, LEFT NONDOMINANT SIDE, LATE EFFECT OF EMBOLIC STROKE
 
 
 
 
For patients and families reviewing the medical record, this document was created for the purpose of communication between members of your healthcare team. It may contain medical terminology and abbreviations that may be difficult to understand. This is NOT intended to communicate information directly to patients. While we are happy to review any questions you may have regarding this encounter, you are still encouraged to review details of your general healthcare and chronic conditions with your primary care provider.
 
History obtained from chart review and the patient
 
Patient's native language was confirmed and interpreter services was offered. 
 SSC Procedure Interpreter List: Self - Patient prefers to use own English skills 
 
Chief complaint NUMBNESS (BIBA from SNF w/ cc left sided arm and foot numbness x10 days, hx prior CVA about 15 years prior, EMS states neg on stroke scale, A&O 4, ambulatory per EMS.)
 
 
 
HISTORY OF PRESENT ILLNESS
Chief Complaint
Patient presents with
•
NUMBNESS
 
 
BIBA from SNF w/ cc left sided arm and foot numbness x10 days, hx prior CVA about 15 years prior, EMS states neg on stroke scale, A&O 4, ambulatory per EMS.
 
 
Mr. Xuan Wei is a 68 Y male with history of ischemic stroke with Left arm and leg weakness one month ago who presents to the Emergency Department with left arm and leg tingling. 
 
He noticed the tingling around 2 weeks ago.  He has had no weakness in his arms or legs recently. When asked about his stroke he does not remember the symptoms or why he was evaluated. A & O x 4 today. He has persistent peripheral visual field deficits bilaterally since the stroke. No changes in vision. No chest pain, belly pain, headache, n/v, lightheadedness, LOC. He lives at an assisted living home. 
 
 
 
Past Medical History
Active Ambulatory Problems
 
Diagnosis
Date Noted
•
PPD POSITIVE
03/17/2017
•
MEDI-CAL GMC CARE COORDINATION
02/14/2020
•
HTN (HYPERTENSION)
03/06/2020
•
HYPERLIPIDEMIA
03/06/2020
•
HX OF LARYNGEAL CANCER
03/06/2020
•
HX OF ISCHEMIC STROKE
03/06/2020
•
HX OF COLONOSCOPY
03/06/2020
•
ORTHOSTATIC HYPOTENSION
10/12/2020
•
GERD (GASTROESOPHAGEAL REFLUX DISEASE)
10/12/2020
•
HX OF HEPATITIS C
08/01/2007
•
CHRONIC HEPATITIS B
05/02/2008
•
LACTIC ACIDOSIS, UNSPECIFIED
08/20/2022
•
COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)
08/20/2022
•
HX OF UPPER GASTROINTESTINAL BLEED
08/21/2022
•
ATHEROSCLEROSIS OF AORTA
03/10/2023
•
PREDIABETES
04/04/2023
•
LEFT BUNION
05/10/2023
•
PAPILLOMA
06/15/2023
•
PERIPHERAL ARTERY DISEASE, UNSPECIFIED TYPE
06/19/2026
•
HEMIPLEGIA & HEMIPARESIS, LEFT NONDOMINANT SIDE, LATE EFFECT OF EMBOLIC STROKE
07/16/2026
•
LEFT HOMONYMOUS HEMIANOPIA, LATE EFFECT OF STROKE
07/20/2026
•
CONSTIPATION
07/20/2026
•
INSOMNIA
07/20/2026
 
Additional diagnoses from the Past Medical History section
Diagnosis
Date
•
TOBACCO SMOKER
3/6/2020
 
History reviewed. No pertinent surgical history.
 
Social History: 
 
Social History
 
Socioeconomic History
•
Marital status:
Married
 
 
Spouse name:
None
•
Number of children:
None
•
Years of education:
None
•
Highest education level:
None
Tobacco Use
•
Smoking status:
Former
 
 
Current packs/day:
0.00
 
 
Average packs/day:
1 pack/day for 35.0 years (35.0 ttl pk-yrs)
 
 
Types:
Cigarettes
 
 
Start date:
10/20/1985
 
 
Quit date:
10/20/2020
 
 
Years since quitting:
5.8
Vaping Use
•
Vaping status:
Never Used
Substance and Sexual Activity
•
Alcohol use:
Never
•
Drug use:
Never
 
E-Cigarettes/Vaping 
 
 
Questions
Responses
 
E-Cigarette/Vaping Use
Never User
 
Passive Exposure
No
 
Counseling Given
No
 
 
 
E-Cigarette/Vaping Substances 
 
 
Questions
Responses
 
Nicotine
No
 
THC
No
 
CBD
No
 
 
 
 
 
Medications:
No current facility-administered medications for this encounter.
 
Current Outpatient Medications
Medication
Sig
Dispense
Refill
•
Polyethylene Glycol 3350 (MIRALAX/GLYCOLAX) 17 gram/dose Oral Powd
Mix 17 Grams in 4 to 8 ounces of water or juice and drink by mouth daily as directed for constipation
119 g
0
•
Sennosides (SENOKOT) 8.6 mg Oral Tab
Take 1 tablet by mouth 2 times a day Hold for loose stools.
14 tablet
0
•
Omeprazole (PriLOSEC) 40 mg Oral CPDR SR Cap
Take 1 capsule by mouth daily 30 minutes before a meal
7 capsule
0
•
Atorvastatin (LIPITOR) 80 mg Oral Tab
Take 1 tablet by mouth daily to prevent heart attacks and strokes
90 tablet
2
•
Diclofenac Sodium (VOLTAREN ARTHRITIS PAIN) 1 % Top Gel
Apply 4 Grams to affected area(s) 2 times a day as needed for pain
200 g
0
•
blood sugar diagnostic (OneTouch Verio test strips) Misc Strips
Use 1 strip as directed every morning to measure blood sugar
100 Strip
1
•
traZODone (DESYREL) 50 mg Oral Tab
Take 2 tablets by mouth daily at bedtime
200 tablet
1
•
lancets (OneTouch Delica Plus Lancet) 30 gauge Misc Misc
Use 1 lancet as directed every morning to measure blood sugar
100 Each
0
•
Albuterol (PROAIR/PROVENTIL/VENTOLIN) 90 mcg/actuation Inhl HFAA
Inhale 2 puffs by mouth every 4 hours as needed for quick relief of asthma symptoms . For use at school or work. 100 days supply for asthma is 1 canister
6.7 g
1
•
Tiotropium-Olodaterol (Stiolto Respimat) 2.5-2.5 mcg/actuation Inhl Mist
Inhale 2 Puffs by mouth daily . Use at the same time each day
12 g
3
 
No outpatient medications have been marked as taking for the 8/21/26 encounter (Hospital Encounter).
 
 
Allergies:  Sulfa (sulfonamide antibiotics)
 
PHYSICAL EXAM:
Vitals: BP 140/103  | Pulse 76  | Temp 98.8 °F (37.1 °C)  | Resp 16  | Wt 82.7 kg (182 lb 5.1 oz)  | SpO2 97%  | BMI 27.72 kg/m² 
Physical Exam
Vitals and nursing note reviewed. 
Constitutional:  
   General: He is not in acute distress.
HENT: 
   Head: Normocephalic and atraumatic. 
   Mouth/Throat: 
   Mouth: Mucous membranes are moist. 
   Pharynx: Oropharynx is clear. No oropharyngeal exudate. 
Eyes: 
   Extraocular Movements: Extraocular movements intact. 
   Conjunctiva/sclera: Conjunctivae normal. 
   Pupils: Pupils are equal, round, and reactive to light. 
Cardiovascular: 
   Rate and Rhythm: Normal rate and regular rhythm. 
   Heart sounds: Normal heart sounds. 
Pulmonary: 
   Effort: Pulmonary effort is normal. 
   Breath sounds: Normal breath sounds. 
Abdominal: 
   General: Abdomen is flat. 
   Palpations: Abdomen is soft. 
   Tenderness: There is no abdominal tenderness. 
Musculoskeletal:    
   General: No swelling or tenderness. Normal range of motion. 
   Cervical back: Normal range of motion and neck supple. 
   Right lower leg: No edema. 
   Left lower leg: No edema. 
Skin:
   General: Skin is warm and dry. 
Neurological: 
   Mental Status: He is alert and oriented to person, place, and time. 
   Cranial Nerves: No cranial nerve deficit. 
   Sensory: Sensory deficit present. 
   Motor: No weakness. 
   Coordination: Coordination normal. 
   Comments: No dysmetria on finger to nose testing. No weakness in face, upper, or lower extremities. Ambulates well with walker 
 
​ 
 
 
Initial assessment/Care plan:
Differential diagnosis includes but not limited to stroke, TIA, radiculopathy, 
 
Consultations obtained: neurology
 
RESULTS OF DIAGNOSTIC STUDIES AND INDEPENDENT INTERPRETATION
Recent Results (from the past 24 hours)
CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)
 
Collection Time: 08/21/26  8:20 PM
Result
Value
Ref Range
 
Estimated Glomerular Filtration Rate
>60
>=60 mL/min/1.73 m2
 
Sodium
138
135 - 145 mEq/L
 
Potassium
4.0
3.5 - 5.3 mEq/L
 
Chloride
107
100 - 111 mEq/L
 
CO2
26
24 - 33 mEq/L
 
Anion gap, ser/plas
5
5 - 16 mEq/L
 
BUN
12
7 - 27 mg/dL
 
GLUCOSE, RANDOM
130
60 - 159 mg/dL
 
Creatinine
0.95
<=1.34 mg/dL
CBC W AUTOMATED DIFFERENTIAL
 
Collection Time: 08/21/26  8:20 PM
Result
Value
Ref Range
 
WBC COUNT
5.1
3.7 - 11.1 K/uL
 
Red blood cells count
4.48
4.10 - 5.70 M/uL
 
Hgb
13.2
13.0 - 17.0 g/dL
 
Hematocrit
39.1
39.0 - 51.0 %
 
MCV
87
80 - 100 fL
 
RDW, RBC
12.2
11.5 - 16.5 %
 
Platelets count
157
140 - 400 K/uL
 
RBC's, nucleated
0
<=0 /100WC
WBC AUTO DIFF
 
Collection Time: 08/21/26  8:20 PM
Result
Value
Ref Range
 
Neutrophils, Automated Count
3.0
1.8 - 7.9 K/uL
 
Lymphocytes, Automated Count
1.6
0.9 - 3.2 K/uL
 
Monocytes, Automated Count
0.4
0.3 - 0.9 K/uL
 
Eosinophils, Automated Count
0.1
0.0 - 0.4 K/uL
 
Basophils, Automated Count
0.0
0.0 - 0.1 K/uL
 
Immature Granulocytes, Automated Count
0.0
0.0 - 0.1 K/uL
 
Neutrophils %, Automated count
59
%
 
Lymphocytes %, Automated count
31
%
 
Monocytes %, Automated Count
8
%
 
Eosinophils %, Automated Count
1
%
 
Basophils %, Automated Count
0
%
 
Immature Granulocytes %, Automated Count
0
%
 
 
 
====================   CT HEAD
Result Date: 8/21/2026
    CT HEAD WITHOUT CONTRAST     ** HISTORY **:  68 years old,  Neuro deficit, acute, stroke suspected 2 weeks of left arm and leg weakness   ** TECHNIQUE **:  CT images of the head acquired without intravenous contrast.   CTDI: 40.54 mGy  DLP: 648.57 mGy-cm   COMPARISON: CTs 7/18/2026, 7/16/2026   ** FINDINGS **:   BRAIN PARENCHYMA: No acute hemorrhage. No mass effect or herniation.   Stable encephalomalacia in the right temporal occipital lobe. Stable foci of encephalomalacia in the left frontal lobe and left occipital lobe. Chronic lacunar infarct in the right internal capsule and right thalamus.   VENTRICLES/EXTRA-AXIAL SPACES: Ventricles remain within normal limits. No extra-axial fluid collection.   EXTRACRANIAL STRUCTURES: Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are clear.   
 
IMPRESSION:         1.   No acute intracranial abnormality.       2. Chronic infarct in the distribution of the right posterior cerebral artery.       3. Chronic infarcts in the left frontal lobe and left occipital lobe and chronic lacunar infarcts in the right internal capsule and right thalamus.        
 
 
 
 
EKG reviewed 
EKG: (my reading) normal sinus rhythm
 
 
 
MDM
Patient is a 68 Y male presenting to the ED with chief complaint of arm and leg tingling for 2 weeks. 
 
Patient with mild dementia having difficulty sharing all details of history, however A & O x 3. 
 
Patients symptoms ongoing for 2 weeks, thus not a candidate for TNK or thrombectomy if acute ischemia is etiology. Reassured as no weakness or motor deficits on exam. Patient ambulating well with walker. Vision changes stable from prior stroke. Head CT neg for acute intracranial pathology showing chronic, stable ischemic changes known on prior imaging. Head and neck CTA pending to determine appropriate out patient follow up. 
 
Pt had incomplete data recording on cardiac monitoring. Initiated ziopatch for reevaluation of potential occult afib which was suspected following stroke evaluation one month ago. Called facility and confirmed patient has been receiving plavix daily. 
 
Discharge back to facility pending CTA of head and neck. 
 
 
 
DISPOSITION
pending
 
Electronically Signed by ROSE-CARMEL ANN GODDARD MD
 
I have reviewed the clinical diagnoses listed below which were considered in the care of this patient.  At the time of this visit there are no changes in these conditions unless otherwise noted.  The patient will be advised to follow up after discharge with their PCP or appropriate specialist as treatment warrants.  
 
Clinical Diagnoses:  
 
 
CHRONIC HEPATITIS B
 
MEDI-CAL GMC CARE COORDINATION
 
HTN (HYPERTENSION)
 
HYPERLIPIDEMIA
 
GERD (GASTROESOPHAGEAL REFLUX DISEASE)
 
COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)
 
ATHEROSCLEROSIS OF AORTA
 
PERIPHERAL ARTERY DISEASE, UNSPECIFIED TYPE
 
HEMIPLEGIA & HEMIPARESIS, LEFT NONDOMINANT SIDE, LATE EFFECT OF EMBOLIC STROKE
 
