1709: 58-year-old African American male presents to the office looking to establish primary care. The client has not had a primary healthcare provider in over eleven years. The client requests a physical examination. The client reports that two months ago, he started noticing changes in his bowel habits, which alternate between diarrhea and constipation. The symptoms are accompanied by occasional dark, tarry stools. This past week, he has had constant abdominal pain that has ranged from a 5/10 to a 7/10 on the Numerical Rating Scale. He describes the pain as 'dull.' He reports that his diet has not changed, and he primarily eats red meat and sandwiches made with luncheon meats and occasionally vegetables. Currently, the client takes a daily aspirin and a multivitamin. He reports a medical history of oral herpes simplex and high blood pressure. He is overweight. He smokes cigarettes daily. On assessment, the client is alert and fully oriented, skin is warm and dry. Lung sounds are clear; the apical pulse is regular. Bowel sounds are active in all quadrants, with no abdominal distention. Capillary refill less than 3 seconds. Peripheral pulses palpable, 2+. Vital signs: T 97.5° F (36.4° C), P 97, RR 18, BP 161/92, pulse oximetry reading 96% on room air.

1741: 

1719:

• Point of care (POC) hemoglobin and hematocrit
• Guaiac-based fecal occult blood test (gFOBT)