{ "generation": "\n\nPatient Details\n\n* Full Name: Sarah Williams\n* Date of Birth (DOB): 15/03/1982\n* Gender: Female\n* Patient ID or Record Number: 002345A\n\nAllergies\n\n* Penicillin\n\nMedications\n\n* Fluticasone nasal spray\n\nMedical History\n\n* Seasonal allergic rhinitis\n\nCurrent Problems\n\n* Sinusitis (acute)\n\nDiagnostic Results\n\n* No imaging performed; diagnosis based on symptoms and physical exam\n\nImmunizations\n\n* Influenza vaccine (2023)\n* COVID-19 booster (2023)\n\nCare Plan\n\n* Ongoing treatments: Continue Fluticasone nasal spray\n* Lifestyle modifications: Use saline nasal rinse twice daily, avoid known allergens\n* Follow-up schedule: Reassess in 7 days if no improvement\n* Patient education: Discussed self-management strategies and symptom duration\n* Red flags to monitor: Persistent fever, facial swelling, vision changes\n\nAdditional Considerations\n\n* If no improvement after 10 days, consider initiating high-dose intranasal corticosteroids (e.g. mometasone 200 mcg twice daily for 14 days).\n* If symptoms persist beyond 3 weeks or red flags emerge, reassess or consider referral.\n* Consider urgent referral for suspected neoplasm if persistent unilateral nasal obstruction, discharge, or swelling is present.\n* Take into account: Evidence that antibiotics make little difference to how long symptoms last or the proportion of people with improved symptoms.\n* Take into account: Evidence that withholding antibiotics is unlikely to lead to complications.\n* Take into account: Possible adverse effects of antibiotics, mainly diarrhoea and nausea.\n* Take into account: Factors that might make a bacterial cause more likely: symptoms for more than 10 days, discoloured or purulent nasal discharge, severe localized pain (often unilateral, particularly pain over teeth and jaw), fever greater than 38°C, and marked deterioration after an initial milder phase (double sickening).\n* A back-up antibiotic may be preferred when a bacterial cause is more likely.\n* If a back-up antibiotic prescription is given, advise the person to: Take the antibiotic if symptoms do not improve within 7 days or worsen rapidly or significantly at any time. Seek medical help if symptoms worsen rapidly or significantly despite taking the antibiotic or if the antibiotic has been stopped because it was not tolerated." }