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MEDICATIONS: Lipitor, atenolol.

ALLERGIES: No known drug allergies.

SOCIAL HISTORY: She is up-to-date on immunizations, here with multiple family members.

REVIEW OF SYSTEMS: GI: See HPI. GU: No history of UTI. RESPIRATORY: No cough. SKIN: No rash. All other systems negative.

PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 36.9, heart rate 78, respiratory rate 16, blood pressure 169/84.
GENERAL: The patient is alert, oriented x3, does not appear to be toxic or significantly dehydrated.
HEENT: Normocephalic, atraumatic. Pupils are equal, round, reactive to light, extraocular muscles are intact. Oropharynx clear, moist.
NECK: Supple. No lymphadenopathy.
LUNGS: Clear to auscultation bilaterally.
CARDIOVASCULAR: Regular rate and rhythm.
CHEST: No retractions, no reproducible tenderness.
BACK: No costovertebral angle tenderness.
ABDOMEN: Soft, nontender, nondistended, normal bowel sounds.
EXTREMITIES: Left lower extremity, foot reveals purple second toe. The proximal phalangeal joint has exposed bone. There is no evidence of any purulence or drainage, and appears to be essentially dry gangrene. Patient does have some mild purple discoloration proximal to the toe, but it is fairly minimal. Remainder of his toes are unremarkable in appearance. The patient has a palpable dorsalis pedis pulse. Right foot examination is unremarkable.
SKIN: As above, otherwise negative for any acute changes.
NEUROLOGIC: Patient does have decreased sensation to the foot.
GU/RECTAL: Deferred.
PSYCHIATRIC: Normal affect.