Zoe Adams reports persistent joint pain and stiffness, particularly in her hands and knees. Morning stiffness lasts approximately 2 hours. Patient notes some improvement with current medication regimen but still experiences fatigue. Physical examination reveals mild synovitis in the metacarpophalangeal joints of both hands and tenderness in the right knee. 15/05/2023: Blood tests show CRP 12 mg/L (elevated), ESR 28 mm/hr (elevated), RF positive, anti-CCP antibodies positive. X-ray of hands reveals early erosive changes in the MCP joints bilaterally. Ultrasound of right knee shows moderate effusion and synovial thickening. Complete blood count, liver function tests, and renal function within normal limits. Continuing methotrexate 15 mg weekly and prednisone 5 mg daily. Increasing hydroxychloroquine to 400 mg daily. Prescribed naproxen 500 mg twice daily for pain management. Referral to physiotherapy for knee exercises. Follow-up appointment scheduled in 8 weeks. Will reassess disease activity and consider biologics if inadequate response to current treatment.

Date and Recipient: 15 May 2023 Dr. Jane Doe 123 Medical Center Drive Cityville, State 12345 Patient Details and Diagnosis: Re: Zoe Adams (DOB: 17/09/1985) 1. Type 2 Diabetes Mellitus, diagnosed 2015 2. Hypertension, diagnosed 2018 3. Obesity (BMI 32) 4. Family history of cardiovascular disease (father had myocardial infarction at age 58) 5. Appendectomy, 2002 Thank you for asking me to see Zoe Adams, a 37-year-old female, today for management of her Type 2 Diabetes Mellitus and associated complications. Zoe presented with concerns about her recent blood glucose readings, which have been consistently elevated over the past month. She reports adhering to her prescribed metformin regimen but admits to struggling with dietary compliance. Her most recent HbA1c, taken two weeks ago, was 8.2% (66 mmol/mol), indicating suboptimal glycemic control. Blood pressure today was 142/88 mmHg, which is above her target range despite current antihypertensive therapy. Zoe denies any symptoms of peripheral neuropathy or visual disturbances. She reports no known allergies. I have suggested intensifying Zoe's diabetes management plan. This includes increasing her metformin dosage from 1000mg twice daily to 1500mg twice daily, and initiating a GLP-1 receptor agonist, specifically liraglutide 0.6mg subcutaneously once daily, to be titrated up as tolerated. I have also recommended a referral to a registered dietitian for personalized nutritional counseling to improve dietary adherence. Regarding her hypertension, I propose adding amlodipine 5mg daily to her current regimen of lisinopril. To address her obesity, I have discussed the benefits of a structured weight loss program and increased physical activity. I would appreciate if you could arrange for a follow-up appointment in 3 months to reassess her glycemic control and blood pressure, with repeat HbA1c and lipid profile tests prior to the visit. Once again thank you for the kind referral. Dr. Smith Footer: cc: Dr. Robert Johnson, Endocrinologist Dr. Sarah Lee, Cardiologist

The Treating Doctor: Dr. Chong Southport Child Development Centre 123 Main Street Southport, QLD 4215 Fax: (07) 5555 5555 Dear Doctor: Dear Dr. Smith Re: JOHN DOE DOB: 15/06/2015 URN: 987654 Thank you for referring John Doe, who I saw today in the Child Development Clinic at Southport. I appreciate the opportunity to be involved in his care. BACKGROUND: John is a 7-year-old boy referred for assessment of developmental concerns, particularly in the areas of speech and social interaction. As you are aware, John has a history of recurrent ear infections and was diagnosed with mild hearing loss at age 3. His parents report ongoing difficulties with speech clarity and social communication. Current Medications: • Cetirizine 5mg orally once daily PROGRESS: Family Situation: John lives with both parents and a younger sister. His mother reports increased stress at home due to John's behavioural challenges. Physical Health: John has had no recent illnesses or hospitalisations. His hearing was last tested 6 months ago, showing stable mild conductive hearing loss bilaterally. Development: John's speech remains delayed for his age, with difficulty articulating complex sounds and limited use of full sentences. His receptive language appears better than expressive. Social interactions are limited, with John preferring solitary play and showing little interest in peers. On examination, John's height was 122cm (50th percentile - tracking) and weight was 23kg (45th percentile - tracking). This calculates his BMI at 15.5 (40th percentile - tracking). Blood pressure was 100/60. John appeared well-nourished and made limited eye contact during the assessment. No dysmorphic features were noted. The examination was otherwise unremarkable. FURTHER INVESTIGATION RECOMMENDED: 1. Comprehensive speech and language assessment 2. Autism Spectrum Disorder (ASD) assessment 3. Updated audiology assessment MANAGEMENT RECOMMENDATIONS: 1. Referral to speech pathologist for detailed assessment and therapy 2. Referral to paediatric psychologist for ASD assessment 3. Continue current dose of Cetirizine for allergies 4. Encourage structured play activities at home to promote social interaction 5. Provide visual supports and schedules to assist with daily routines FOLLOW-UP: John will be reviewed in the Child Development Clinic in 3 months to discuss the results of the recommended assessments and adjust the management plan accordingly. Kind regards, Yours sincerely, Dr. Chong Paediatrician MBBS, FRACP Provider No: 1234567A Southport Child Development Centre Phone: 0412 345 678 cc: Mr and Mrs Doe 456 Oak Street Southport, QLD 4215