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

Date and Recipient: 15 May 2023 Dr. Jane Doe 123 Medical Street Cityville, NSW 2000 Patient Details and Diagnosis: Re: Zoe Adams (DOB: 15/09/1985) Diagnosis: 1. Type 2 Diabetes Mellitus 2. Hypertension 3. Obesity (BMI 32) 4. History of appendectomy (2010) I reviewed Zoe Adams today for her ongoing management of type 2 diabetes and hypertension. Her blood glucose readings have been consistently within target range (5.0-7.8 mmol/L) over the past month. Blood pressure today was 132/82 mmHg, which is an improvement from her previous visit. Zoe reports no new symptoms or concerns. She denies any episodes of hypoglycemia. Allergy to penicillin noted. I have suggested increasing her daily walking to 45 minutes and maintaining her current medication regimen. I would appreciate if you could arrange for a lipid profile and HbA1c test to be conducted before our next review in three months. Additionally, I recommend a referral to a dietitian for further weight management support. Once again thank you for involving me in this patient's care. Dr. Smith Footer: CC: Dr. Michael Johnson (GP), Dr. Sarah Lee (Endocrinologist) RECALL: 3 months

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.