Mar 12, 2026 11:58 To: +16042339777 Page: 45/46 From: Foremed Medical Clinic Fax: 16043985614

FRASER HEALTH AUTHORITY Emerg Note
Royal Columbian Hospital HOLAND,MARK THOMAS
RC0473383/25

During our exam, he became quite agitated, pointing his finger at me. He was redirectable and he
had a quite logical thought form although it was quite fixated on his health.

I do not detect any primary thought disorder or primary psychotic disorder although I will let the
psychiatrist make this final assessment.

Bilateral equivalent radial pulses
Cerebellar testing [Is normal to finger-to-nose
Cranial nerve screening normal

Due to patient declining, I did not perform the remainder of the physical exam.

Relevant Investigations:
None

Assessment and Plan:

I have attempted to workup this patient today but he has told me that he does not want any blood
work because the last time he had blood work “he passed out” I reassured him that we can do the

blood work today and that if he feels vasovagal that we can lay him down and this would be a safe

space for him, he still tells me that he would fike to refuse and actually became quite aggressive at
this point raising his voice and pointing his finger in a threatening manner towards me. Telling me
“no! {do not want blood work today, I am not in the mental state for that”

This patient still has capacity and is not certifiable under the mental health act and psychiatry has
cooperated this assessment. Therefore we will not complete a medical workup today understanding
that in the future it would be good to check his labs and a TSH.

Psychiatry has seen this patient and will manage his ultimate disposition.
Appropriate instructions were discussed and agreed to,

Parker D. Nann (R3 EM) discussed with and on behalf of Dr. Lim
EP staff note: Patient discussed, agree

Discharge Plan
Discharge
Reason For Visit: MENTAL HEALTH

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Meditech Report !D: 0503-00199 3of4

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