46   years old female opa t
known to have  dm for the last     19    years 
chronic  kdiney disease  with  base line creatinien  2,2 
pci  in 2020 


echo  was done a  
left  venticuler    ejectio fraction   45% 
moderate   diastolic   dysfunction 
mild  pericardial   effusion 
mild  tricusped  regurgitation 
ivc   mild  dilaterd 

medication 
asa   100 mg once 
conconr 
liponil 
plavix 
insulin    sliding sca



plN 
ADD   EMPA 
ADD  LOZAR 
ADD  ALFACAL  RTC AFTER   LABS  