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This is an FNP who butchers the pronounciation of words, usually I can figure out what she is saying, but not this time.
This is listed in past surgical history: Internal cardiac defibrillator implanted. Ashcalf implantation. Fistula on left arm.
The patient is on dialysis and has had pulmonary edema related to renal failure and sleep apnea.
Thanks for any help with this one!