Infоrmаtiоn / pоtentiаl problems you cаn identify from the profile alone (before speaking to the patient): NOTE: This is not all-inclusive. You may have come up with other information in addition to what is listed below. The patient appears to have T2DM based on prescriptions for Trulicity and Jardiance The patient likely has a history of high triglycerides since she was prescribed a fibrate in the past The patient has several cardiovascular medications, which points toward a likely history of cardiovascular issues: She may or may not have HTN since she is on lisinopril (first line for HTN) and metorpolol (second line for HTN) She may have had an MI as she is on medications typically prescribed after an MI (aspirin, beta blocker, ACE, statin), although she does not have an active prescription for nitroglycerin She is on dual anti-platelet therapy. This may be appropriate depending on patient's cardiovascular history (was a stent placed recently?). She may or may not have heart failure (on lisinopril / metoprolol ER which are both recommended for mortality benefit) but it is unlikely since she is not on a diuretic (unless she is very early stages and having no issues with volume overload) The patient hasn't filled gemfibrozil since March or atorvastatin since June. This could be a potential adherence problem - need to find out why these haven't been filled. The patient is not on metformin, which is typically first line for T2DM if tolerated and not contraindicated - need to find out why she is not on this medication. She was prescribed a course of cephalexin earlier this year. One possible indication for this antibiotic would be a UTI (although we often use different agents for this). If this was used to treat a UTI, this could be indicative of side effects from the patient's Jardiance. There is a clinically significant drug interaction between atorvastatin and gemfibrozil which may need to be addressed / could affect the plan going forward (depending on what is learned from the patient--it appears based on fill history that the gemfibrozil may not be a current med)