73   years old female patient 
HYPERTENSION FOR THE LAST 
DM    FOR THE LAST     10  YEARS 
DLD 
IHD   AF    WITH  GOOOD  EJECTION FRACTION 
WAS  DOING  WELL  BUT  SHE WAS   TAKING  NSAID      FR THE  KNEE  OSTEOARTHRITIS 

MEDICATIONS 
QUEST  5 MG 1X2
CODIOVAN  160/12.5
ALLORIL   100 MG ONCE
TEGRETOL  200 MG ONCE
ACAMOL   500 MG ONCE
VIT  C
LOLIP  20
NECIUM
METFORMIN  850 MG OCNE

CREATININE  1.7 
BUN   60 
CBC   13 
LDL  70 

PLAN 
ADD  DEFLAZACORT 
ADD   REJOINT 
RECHECK THE    URIC ACID AND  CREATININE  IF  HIGH   THEN   CONSIDER  SWITCHING THE   CO DIOVAN 