Case description for C-Takes documenting:
Setting: Outpatient.
Specialty: General Surgery. 
Note detail level (1-5): 3.
Level of abbreviation (Low/Medium/High): Medium. 

CC/HPI: Mrs. X is a 66 yo caucasian woman w/ a known hist of umbilical hernia who presents to the clinic for f/u of a suspected umbilical hernia s/p panni. The panni was performed on 2 Feb 2010. She presented to the clinic 3 weeks ago for 'redness' and TTP periumbilically. At that time an umbilical hernia was suspected, however the US at that time was documented as being negative. Patient was scheduled for f/u today. She describes that it feels worse after being "on her feet all day". Better or gone when she lies down. When she eats it feels like "her guts are going to pop out". It also feels like she needs to burp all the time like "she drank a soda". This is the first day she has been able to get around relatively comfortably w/o her abdominal binder. She can not eat much due to all of the above. She states that the symptoms she is experiencing are consistent with the symptioms she felt 17 years ago when she had an umbilical hernia. 
ROS: Denies n/v/cp/sob/f/c/ns. Reflux/burping as noted. Consistently constipated and when she bears down now  s/p panni, she can not feel herself deficate. She does have atleast one bowel a day on average. She has had bladder dysfunction for which she is seeing OBGYN, however it seems to have began before the panni.
PMHx: Umbilical hernia 17 years ago, thyroid cancer, gall bladder disease, HTN.

PSHx: Panni, Breast reduction, Cholcystectomy, partial thyroidectomy.

Meds: Lisinopril, Mobec, Primpro, Synthroid, Prilosec, Zocar, Asp, Zirtec, Hydrochlorothyazide.

Allergies: Sulfa.
PE: CV: No r/m/g. RRR. Pulm: CTAB. Abd: Inspection of the abdomen revealed NBS. Periumbilical erythema with TTP was appreciated. Bulging at umbilicis on valsalva.
Labs/Ancillary studies: 
US: Revealed no disruption of the abdominal fascia while standing or while standing w/ valsalva.

A/P: 
Umbilical hernia: Mrs. X is a 66 yo woman in no acute distress who is now s/p panni w/ a known history of umbilical hernia 17 years ago with s/s c/w with an umbilical hernia but negative US. 
- Check creatinine with BMP.
- Order CT with PO/IV contrast.
- Schedule f/u after results.