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const fs = require('fs');

// ─── helpers ────────────────────────────────────────────────────────────────
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// ─── DOCUMENT CONTENT ───────────────────────────────────────────────────────
const doc = new Document({
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            new TextRun({ text: 'INTERNAL MEDICINE PRESENTATION - TRUNG VUONG HOSPITAL | ', bold: true, size: 16, color: '1F497D' }),
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    children: [

      // ══════════════════════════════════════════════════════════════════
      // TITLE
      // ══════════════════════════════════════════════════════════════════
      new Paragraph({
        children: [new TextRun({ text: 'INTERNAL MEDICINE CLINICAL PRESENTATION', bold: true, size: 36, color: '1F497D' })],
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        children: [new TextRun({ text: 'Trung Vuong Hospital, Ho Chi Minh City  |  Khoa Noi Tiet - Tong Hop (Endocrinology & General Internal Medicine)', size: 20, color: '555555', italics: true })],
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        children: [new TextRun({ text: 'Admission: 22/06/2026  |  Date of Presentation: 23/06/2026', size: 20, color: '888888' })],
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      }),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 1 - ADMINISTRATIVE DATA
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('I.  ADMINISTRATIVE & DEMOGRAPHIC DATA'),
      spacer(),
      twoColTable([
        ['Patient Full Name', 'Chau Thi Bich Diep'],
        ['Date of Birth', '16/05/1971'],
        ['Age', '55 years'],
        ['Gender', 'Female'],
        ['Nationality', 'Vietnamese'],
        ['Address', 'Ap 1, Xa Vinh Loc, Thanh pho Ho Chi Minh (Xa Vinh Loc, HCMC)'],
        ['Health Insurance No.', 'GD4797936717703790 26'],
        ['Phone', '0931770379026 / 0966483728'],
        ['Hospital Record No. (PID)', '70131126012722'],
        ['Admission No.', '26/014363'],
        ['Lab Sample No.', '220626-2038'],
        ['Admitting Ward', 'Khoa Noi Tiet - Tong Hop (Endocrinology / General Internal Medicine), Room 8'],
        ['Hospital', 'Benh Vien Trung Vuong, 266 Ly Thuong Kiet, P14, Q10, HCMC'],
        ['Admitting Doctor', 'BS. Cao Thi Minh'],
        ['Nursing Care', 'Dang Huu Thao Nhi / Doan Thi Buoi'],
        ['Date of Admission', '22/06/2026 at 07:18'],
        ['Date of Presentation', '23/06/2026'],
        ['Mode of Admission', 'Emergency / Outpatient -> Inpatient (Khoa Cap Cuu -> Noi Tru)'],
        ['Insurance Type', 'BHYT (Health Insurance)'],
        ['Care Level', 'Cap III (Level 3 nursing care)']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 2 - CHIEF COMPLAINT
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('II.  CHIEF COMPLAINT'),
      spacer(),
      p('Fatigue, weakness of the arms and legs, and poor glycemic control with history of Type 2 Diabetes Mellitus not on insulin therapy.', { italics: true }),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 3 - HISTORY OF PRESENT ILLNESS
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('III.  HISTORY OF PRESENT ILLNESS (HPI)'),
      spacer(),

      subHeader('3.1  Polyuria'),
      bullet('Frequency: 3-4 times during the day and 1 time at night'),
      bullet('Volume: variable - correlates with fluid intake (drinks more -> urinates more)'),
      bullet('Patient describes urine as dark in color, suggesting possible dehydration or concentration'),
      spacer(),

      subHeader('3.2  Polydipsia'),
      bullet('Increased thirst present'),
      bullet('Fluid intake: approximately 2 litres per day'),
      spacer(),

      subHeader('3.3  Polyphagia'),
      bullet('Taking 3 meals per day'),
      bullet('Diet consists mainly of rice, fish, meat, and sweet potato'),
      bullet('Does NOT feel hungry or satisfied after eating (persistent appetite)'),
      spacer(),

      subHeader('3.4  Weight Change'),
      bullet('Unintentional weight loss of approximately 10 kg over the past 2 years'),
      bullet('Current weight: 55 kg, Height: implied from BMI 21.5 (approx. 160 cm)'),
      spacer(),

      subHeader('3.5  Fatigue and Weakness'),
      bullet('Generalized fatigue and weakness involving both arms and legs'),
      spacer(),

      subHeader('3.6  Neurological Symptoms (Peripheral Neuropathy)'),
      bullet('Numbness and tingling on the plantar surface of both feet (stocking distribution)'),
      bullet('Pain in legs when walking long distances'),
      bullet('Loss of balance on occasion'),
      bullet('Sweating and shakiness when a meal is missed or delayed (hypoglycemic episodes)'),
      spacer(),

      subHeader('3.7  Cutaneous'),
      bullet('Intermittent itching of both arms; occasional whole-body itching'),
      bullet('Skin: normal with mild dehydration signs; no acanthosis nigricans'),
      spacer(),

      subHeader('3.8  Lower Limb Oedema'),
      bullet('Swelling from mid-lower leg to toes bilaterally, occurring after prolonged walking'),
      spacer(),

      subHeader('3.9  Review of Systems - Negative Findings'),
      bullet('No blurred vision'),
      bullet('No recurrent infections'),
      bullet('Normal wound healing'),
      bullet('No nausea, vomiting, or abdominal pain'),
      bullet('No gestational diabetes history'),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 4 - PAST MEDICAL HISTORY
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('IV.  PAST MEDICAL & SURGICAL HISTORY'),
      spacer(),
      twoColTable([
        ['Diabetes Mellitus Type 2', 'Known - diagnosed previously (ICD-10: E11.9); not previously on insulin'],
        ['Hypertension', 'Yes (ICD-10: I10) - on antihypertensive medication'],
        ['Thyroid Disease', 'Yes (ICD-10: E05 - Hyperthyroidism / Cuong giap); on Thiamazole'],
        ['Dyslipidaemia', 'Yes (ICD-10: E78.2 - Mixed hyperlipidaemia); on Rosuvastatin'],
        ['Cardiovascular', 'Benhco tim do thieu mau cuc bo (Ischaemic Heart Disease, ICD-10: I25.5); on Clopidogrel + Irbesartan'],
        ['Surgical History', 'None documented'],
        ['Allergies', 'None documented (Chua ghi nhan)'],
        ['Previous Hospitalisations', 'Current admission is first documented inpatient stay on this record']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 5 - FAMILY & SOCIAL HISTORY
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('V.  FAMILY & SOCIAL HISTORY'),
      spacer(),
      subHeader('Family History'),
      bullet('Sister: Type 2 Diabetes Mellitus (positive first-degree family history)'),
      bullet('No other known familial conditions documented'),
      spacer(),
      subHeader('Social History'),
      bullet('Smoking: None'),
      bullet('Alcohol: None'),
      bullet('Diet: Rice-based diet with fish, meat, and sweet potato; eats 3 meals daily'),
      bullet('Activity: Normal to mildly limited daily activities; can perform most ADLs independently'),
      bullet('Functional status: Can eat, bathe, dress, do oral care, and ambulate independently (as per nursing assessment - "Doc lap")'),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 6 - PHYSICAL EXAMINATION
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('VI.  PHYSICAL EXAMINATION'),
      spacer(),

      subHeader('6.1  Vital Signs (on Admission 22/06/2026 at 07:18)'),
      twoColTable([
        ['Temperature', '37.0 °C'],
        ['Heart Rate (Pulse)', '100 bpm (Admission) -> 78-82 bpm (subsequent monitoring)'],
        ['Blood Pressure', '130/60 mmHg (Admission) -> 120/60 mmHg (23/06/2026)'],
        ['Respiratory Rate', '20 breaths/min'],
        ['SpO2', '98%'],
        ['Weight', '55 kg'],
        ['BMI', '21.5 kg/m2 (55/21.5 -> height approx 160 cm)'],
        ['GCS', '15/15 (fully alert)']
      ]),
      spacer(),

      subHeader('6.2  General Appearance'),
      bullet('Alert and oriented, cooperative'),
      bullet('Mild signs of dehydration (dry skin)'),
      bullet('No acute distress'),
      spacer(),

      subHeader('6.3  Skin'),
      bullet('Mild dehydration; dry skin with itchiness'),
      bullet('No acanthosis nigricans'),
      bullet('No jaundice, no cyanosis'),
      bullet('Mucous membranes: pink (Hong)'),
      spacer(),

      subHeader('6.4  Cardiovascular'),
      bullet('Regular rhythm (Tim deu)'),
      bullet('No murmurs documented'),
      spacer(),

      subHeader('6.5  Respiratory'),
      bullet('Breathing: Normal pattern (Binh thuong)'),
      bullet('No supplemental oxygen requirement'),
      bullet('No cough or sputum documented (Khong ghi nhan)'),
      spacer(),

      subHeader('6.6  Abdomen'),
      bullet('Abdomen: soft (Bung mem), flat'),
      bullet('No organomegaly on palpation'),
      bullet('Ultrasound (22/06/2026): Liver - no enlargement, smooth surface; Gallbladder - normal wall 3 mm, no stones; Spleen - normal; Pancreas - not visible clearly; Kidneys - not noted; Uterus - small (teo nho); No ascites. Conclusion: NO CURRENT ABNORMAL FINDINGS'),
      spacer(),

      subHeader('6.7  Neurological'),
      bullet('Consciousness: Alert, fully oriented (Tinh tao, tinh tao hoan toan)'),
      bullet('GCS: 15'),
      bullet('Loss of balance: occasional (by history)'),
      bullet('Peripheral neuropathy: Numbness/tingling on plantar surface of feet (bilateral stocking distribution) - by history'),
      spacer(),

      subHeader('6.8  Musculoskeletal (Diabetic Hand Syndrome Assessment)'),
      twoColTable([
        ["Prayer's Sign", 'Normal (negative)'],
        ['Shoulder ROM', 'Normal'],
        ['Tabletop Sign', 'Normal'],
        ["Dupuytren's Contracture", 'Negative'],
        ["Charcot's Foot", 'Absent']
      ]),
      spacer(),

      subHeader('6.9  Lower Extremities'),
      bullet('Bilateral pitting oedema from mid-lower leg to toes (after prolonged walking)'),
      bullet('No ulcers, no wounds documented'),
      bullet('Plantar sensation: reduced (numbness and tingling reported)'),
      spacer(),

      subHeader('6.10  Thyroid'),
      bullet('Thyroid disease known (Cuong giap / Hyperthyroidism) - physical findings not explicitly documented in available records'),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 7 - INVESTIGATIONS
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('VII.  INVESTIGATIONS & LABORATORY RESULTS'),
      spacer(),

      subHeader('7.1  Full Blood Count (FBC) - 22/06/2026'),
      twoColTable([
        ['WBC', '9.69 K/uL  (Ref: 4.4-10.8)  - NORMAL'],
        ['NEU#', '6.11  (Ref: 2.0-6.9)  - NORMAL'],
        ['NEU%', '63.00%  (Ref: 49.0-72.0)  - NORMAL'],
        ['LYM#', '2.70  (Ref: 0.6-3.4)'],
        ['LYM%', '27.80%  (Ref: 20.0-42.2)'],
        ['MONO#', '0.49  (Ref: 0.0-0.9)'],
        ['MONO%', '5.10%  (Ref: 0.0-12.0)'],
        ['EOS#', '0.10  (Ref: 0.0-0.7)'],
        ['EOS%', '1.00%  (Ref: 0.0-0.2)'],
        ['BASO#', '0.08  (Ref: 0.0-2.5)'],
        ['BASO%', '0.80%  (Ref: 0-4)'],
        ['LUC%', '0.22%'],
        ['RBC', '4.74 M/uL  (Ref: 3.8-5.4)  - NORMAL'],
        ['HGB', '14.20 g/dL  (Ref: 12-14.5)  - NORMAL'],
        ['HCT', '43.60%  (Ref: 35-48)  - NORMAL'],
        ['MCV', '92.00 fL  (Ref: 80.0-97.0)  - NORMAL'],
        ['MCH', '30.00 pg  (Ref: 27.0-31.2)  - NORMAL'],
        ['MCHC', '32.70 g/dL  (Ref: 31.8-35.4)  - NORMAL'],
        ['PLT', '212 K/uL  (Ref: 150-450)  - NORMAL'],
        ['MPV', '8.90 fL  (Ref: 5-10)  - NORMAL']
      ]),
      spacer(),

      subHeader('7.2  Biochemistry (Serum) - 22/06/2026'),
      twoColTable([
        ['Creatinine (serum)', '61 umol/L  (Ref: 45-84)  - NORMAL'],
        ['eGFR (CKD-EPI)', '94 mL/min/1.73m2  (Ref: >90)  - NORMAL (G2 borderline)'],
        ['Sodium (Na)', '135 mmol/L  (Ref: 135-145)  - NORMAL'],
        ['Potassium (K)', '4.0 mmol/L  (Ref: 3.5-5.1)  - NORMAL'],
        ['Chloride (Cl)', '102 mmol/L  (Ref: 98-108)  - NORMAL'],
        ['AST (GOT)', '10 U/L  (Ref: <35)  - NORMAL'],
        ['ALT (GPT)', '4 U/L  (Ref: <35)  - NORMAL'],
        ['HbA1c', '12.6%  - SIGNIFICANTLY ELEVATED (Target <7%)'],
        ['Fasting Blood Glucose (DMMM)', '251 mg/dL (13.9 mmol/L)  - SIGNIFICANTLY ELEVATED']
      ]),
      spacer(),

      subHeader('7.3  Thyroid Function Tests - 22/06/2026'),
      twoColTable([
        ['TSH (Thyroid Stimulating Hormone)', '0.0027 uIU/mL  (Ref: 0.35-4.94)  - SUPPRESSED (Hyperthyroid state)'],
        ['Free T4 (FT4)', '1.02 ng/dL  (Ref: 0.70-1.48)  - NORMAL upper range']
      ]),
      spacer(),

      subHeader('7.4  Urinalysis - 22/06/2026'),
      twoColTable([
        ['Urobilinogen', 'Normal'],
        ['Glucose (urine)', '111 mmol/L  - POSITIVE (glycosuria)'],
        ['Ketones', 'Negative'],
        ['Bilirubin', 'Negative'],
        ['Protein', 'Negative'],
        ['Blood (urine)', 'Negative'],
        ['Tbi (Tbi trong)', '1.032  (Ref: 1.003-1.040)  - NORMAL'],
        ['Leukocytes', 'Negative'],
        ['Nitrite', 'Negative'],
        ['pH', '6.0']
      ]),
      spacer(),

      subHeader('7.5  Abdominal Ultrasound - 22/06/2026 at 14:16'),
      bullet('Liver: Normal size, smooth surface; no mass, no dilation of bile ducts'),
      bullet('Gallbladder: Normal wall 3 mm, no stones, normal size'),
      bullet('Biliary tract: no dilation'),
      bullet('Spleen: Normal'),
      bullet('Pancreas: Not clearly visualised'),
      bullet('Bladder: No stones'),
      bullet('Left kidney (D): No stones'),
      bullet('Right kidney (P): No stones'),
      bullet('Uterus: Small/atrophic (teo nho)'),
      bullet('CONCLUSION: No current abnormal findings detected on abdominal ultrasound'),
      spacer(),

      subHeader('7.6  Point-of-Care Blood Glucose Monitoring'),
      twoColTable([
        ['22/06/2026 (admission capillary BG)', '251 mg/dL'],
        ['23/06/2026 capillary glucose (nursing sheet)', 'Not specified in mg/dL, monitoring ongoing'],
        ['Target glucose (inpatient, ADA 2026)', '100-180 mg/dL (pre/intra/post-op or inpatient general)']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 8 - DIAGNOSIS
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('VIII.  DIAGNOSES (ICD-10 CODES)'),
      spacer(),
      twoColTable([
        ['Primary Diagnosis', 'Type 2 Diabetes Mellitus, poorly controlled, not on insulin previously\n(ICD-10: E11.9)'],
        ['Diagnosis 2', 'Hyperthyroidism / Thyrotoxicosis (Cuong giap)\n(ICD-10: E05)'],
        ['Diagnosis 3', 'Hypertension\n(ICD-10: I10)'],
        ['Diagnosis 4', 'Ischaemic Heart Disease (Benh co tim do thieu mau cuc bo)\n(ICD-10: I25.5)'],
        ['Diagnosis 5', 'Mixed Dyslipidaemia\n(ICD-10: E78.2)'],
        ['Complication under evaluation', 'Peripheral Diabetic Neuropathy (R73.9 - hyperglycaemia; neuropathy symptoms present)'],
        ['Nursing Dx 1', 'Impaired self-management of hyperglycaemia related to lack of insulin knowledge'],
        ['Nursing Dx 2', 'Risk for hypoglycaemia (skip-meal pattern)'],
        ['Risk Score', 'Pressure injury risk: 23 points (No significant risk); Fall risk: 35 points (Moderate)']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 9 - TREATMENT (ADA 2026)
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('IX.  TREATMENT & MANAGEMENT PLAN (ADA 2026 STANDARDS OF CARE)'),
      spacer(),

      new Paragraph({
        children: [new TextRun({ text: 'Glycaemic Targets (ADA 2026 - Individualized for this patient)', bold: true, size: 22, color: 'C00000' })],
        spacing: { before: 120, after: 80 }
      }),
      twoColTable([
        ['HbA1c Goal', '<7.0% (current 12.6% -> requires aggressive reduction)'],
        ['Fasting BG Target', '80-130 mg/dL'],
        ['Post-prandial BG Target', '<180 mg/dL'],
        ['Time in Range (TIR)', '>70% (70-180 mg/dL)'],
        ['Time Below Range (TBR)', '<4% (<70 mg/dL)'],
        ['BP Target (DM + HTN)', '<130/80 mmHg (current 120-130/60 - borderline low diastolic; monitor)'],
        ['LDL-Cholesterol Target', '<70 mg/dL (high CV risk with IHD)']
      ]),
      spacer(),

      subHeader('9.1  PHARMACOLOGICAL MANAGEMENT'),
      spacer(),

      heading3('A. DIABETES - GLYCAEMIC CONTROL'),
      spacer(),

      new Paragraph({
        children: [new TextRun({ text: 'Current Hospital Regimen (from medical record 22-23/06/2026):', bold: true, size: 20, color: '2E74B5' })],
        spacing: { after: 60 }
      }),
      bullet('Mixtard 30 (Biphasic Insulin rDNA): 700 IU/10 mL (Isophane insulin crystals 300 IU + Insulin Human rDNA 300 IU)'),
      subBullet('14 IU subcutaneously twice daily (Morning 09:00, Evening 18:00) on admission'),
      subBullet('Increased to 16 IU SC twice daily from 23/06/2026'),
      bullet('Glucophage XR (Metformin Hydrochloride) 750 mg: 1 tablet orally once daily (Evening 17:00)'),
      subBullet('Note: Metformin is ADA 2026 first-line oral agent; continued alongside insulin given adequate renal function (eGFR 94)'),
      bullet('Mebista 50 mg (Sitagliptin/DPP-4 inhibitor) 711: 1 tablet orally once daily (Morning 09:00) - 23/06 onwards'),
      subBullet('ADA 2026: DPP-4i can be added to insulin; modest HbA1c reduction; low hypoglycaemia risk'),
      spacer(),

      new Paragraph({
        children: [new TextRun({ text: 'ADA 2026 Evidence-Based Rationale & Recommendations:', bold: true, size: 20, color: '375623' })],
        spacing: { after: 60 }
      }),
      bullet('Basal-bolus or premixed insulin is appropriate for HbA1c 12.6% with symptomatic hyperglycaemia - ADA 2026 Section 9'),
      bullet('Metformin should be continued unless eGFR <30 mL/min; current eGFR 94 - safe to use'),
      bullet('Given IHD: ADA 2026 recommends GLP-1 RA (e.g., Semaglutide, Liraglutide) with proven CV benefit as add-on therapy - STRONGLY INDICATED once glucose stabilised'),
      bullet('GLP-1 RA not yet in current regimen - recommend initiating after discharge or once glucose control established'),
      bullet('SGLT2 inhibitor (e.g., Empagliflozin) also has CV mortality benefit in IHD - consider addition after discharge'),
      spacer(),

      heading3('B. HYPERTENSION'),
      bullet('Irbesartan 150 mg (ARB): 1 tablet orally once daily (Morning 09:00) - ADA 2026 preferred: ACEi or ARB for DM + HTN + IHD'),
      bullet('Target BP: <130/80 mmHg per ADA 2026'),
      bullet('Note: Current diastolic 60 mmHg - monitor closely; avoid over-treatment'),
      spacer(),

      heading3('C. ISCHAEMIC HEART DISEASE / ANTIPLATELET'),
      bullet('Clopalvix 75 mg (Clopidogrel bisulfate 97.86 mg): 1 tablet orally once daily (Morning 09:00)'),
      bullet('ADA 2026: Antiplatelet therapy with aspirin or clopidogrel recommended for established ASCVD'),
      spacer(),

      heading3('D. DYSLIPIDAEMIA'),
      bullet('Sterolow 20 mg (Rosuvastatin): 1 tablet orally once daily (Evening 18:00)'),
      bullet('ADA 2026: High-intensity statin therapy recommended for DM with established ASCVD (IHD)'),
      bullet('Recommendation: Consider increasing to Rosuvastatin 40 mg or adding Ezetimibe to achieve LDL <70 mg/dL'),
      spacer(),

      heading3('E. HYPERTHYROIDISM'),
      bullet('Thyrozol 5 mg (Thiamazole/Methimazole) 295: 2 tablets orally once daily (Morning 09:00)'),
      bullet('Note: Untreated hyperthyroidism worsens glycaemic control (increased hepatic glucose output, peripheral resistance) - TSH 0.0027 (severely suppressed) requires optimisation'),
      bullet('Consider endocrinology referral for thyroid management; reassess antithyroid dose'),
      spacer(),

      heading3('F. HYDRATION / SUPPORTIVE (Admission Day 22-23/06/2026)'),
      bullet('Ringer Lactate 500 mL with Calcium Chloride, KCl, NaCl (0.135 g:0.3 g:3 g:1.6 g/500 mL): IV infusion on admission'),
      bullet('Rationale: Correct dehydration and electrolyte balance in setting of hyperglycaemia'),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // NON-PHARMACOLOGICAL
      // ══════════════════════════════════════════════════════════════════
      subHeader('9.2  NON-PHARMACOLOGICAL MANAGEMENT (ADA 2026)'),
      spacer(),

      heading3('A. Medical Nutrition Therapy (MNT)'),
      bullet('Diet order: DD01-Com (Rice-based diabetic diet) - hospital standard'),
      bullet('ADA 2026 recommendations:'),
      subBullet('Reduce refined carbohydrates; choose low-glycaemic index foods (avoid sweet potato in excess)'),
      subBullet('Distribute carbohydrate intake evenly across 3 meals; avoid skipping meals (patient has hypoglycaemic episodes when meals are missed)'),
      subBullet('Portion control: limit rice to 1/2 to 3/4 cup per meal'),
      subBullet('Increase non-starchy vegetables (leafy greens, cucumbers) at each meal'),
      subBullet('Limit added sugars and sugary beverages to 0 g/day'),
      subBullet('Protein: lean sources (fish is appropriate); aim 15-20% of total calories'),
      subBullet('Maintain fluid intake of 2 L/day as current'),
      subBullet('Reduce sodium to <2,300 mg/day given hypertension'),
      spacer(),

      heading3('B. Physical Activity (VSCN)'),
      bullet('ADA 2026: At least 150 min/week moderate-intensity aerobic activity (e.g., brisk walking)'),
      bullet('Start with 30 minutes of low-impact exercise (walking, swimming) 5 days per week'),
      bullet('Given lower limb oedema and leg pain: begin with seated exercises and short flat-surface walks'),
      bullet('Resistance training 2-3x/week when tolerated'),
      bullet('Monitor glucose before and after exercise; treat hypoglycaemia promptly'),
      bullet('Current hospital note: VSCN (physical therapy) initiated - "Binh thuong" (normal)'),
      spacer(),

      heading3('C. Diabetes Self-Management Education & Support (DSMES)'),
      bullet('ADA 2026: DSMES is recommended at diagnosis, annually, at transition points'),
      bullet('Teach: Blood glucose self-monitoring technique (SMBG) - target fasting 80-130 mg/dL'),
      bullet('Hypoglycaemia recognition and treatment (15-15 rule: 15 g fast-acting carbohydrate; recheck in 15 min)'),
      bullet('Insulin injection technique, rotation sites, storage'),
      bullet('Sick-day management rules'),
      bullet('Foot care: daily foot inspection, proper footwear, moisturising (avoid between toes)'),
      bullet('Importance of NOT skipping meals (patient has documented hypoglycaemia on meal skip)'),
      bullet('Nurse educator notes (GDSK items documented in record):'),
      subBullet('GDSK.3: Diabetic diet - reduce sweet, limit rice, do not overeat, avoid high-sugar foods'),
      subBullet('GDSK.4: Medication adherence'),
      subBullet('GDSK.5: Physical activity - exercise 30 min daily'),
      subBullet('GDSK.6: VSCN encouragement'),
      subBullet('GDSK.7: Recognize warning signs - fever, cough, fatigue, sweating, nausea, eye changes'),
      subBullet('GDSK.8: Patient safety (fall prevention, room orientation, call bell use)'),
      spacer(),

      heading3('D. Blood Pressure & Lipid Monitoring'),
      bullet('BP monitoring: Every nursing shift (documented); target <130/80 mmHg'),
      bullet('Lipid panel: Repeat in 3 months after statin initiation/adjustment'),
      spacer(),

      heading3('E. Smoking & Alcohol Cessation'),
      bullet('Patient denies smoking and alcohol use - document as protective factor; reinforce abstinence'),
      spacer(),

      heading3('F. Monitoring Schedule (ADA 2026)'),
      twoColTable([
        ['HbA1c', 'Every 3 months until target reached; then every 6 months'],
        ['Fasting glucose / CGM', 'Daily self-monitoring; CGM recommended by ADA 2026 for all T2DM on insulin'],
        ['Lipid panel', 'Annually (or 3-monthly if adjusting statin)'],
        ['Kidney function (Cr, eGFR, urine ACR)', 'Annually (eGFR 94 currently - normal; ACR not yet documented)'],
        ['Liver enzymes (AST/ALT)', 'Annually (currently normal)'],
        ['Thyroid function (TSH/FT4)', 'Every 3-6 months (TSH suppressed - requires close follow-up)'],
        ['Foot examination', 'Every clinic visit; comprehensive annually'],
        ['Eye examination (Dilated fundoscopy)', 'Annually (no retinopathy documented yet)'],
        ['Blood pressure', 'Every visit'],
        ['Dental care', 'Biannually'],
        ['Vaccinations', 'Influenza annually; Pneumococcal; COVID-19 booster per local guidelines']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 10 - CLINICAL COURSE
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('X.  CLINICAL COURSE (INPATIENT 22-23/06/2026)'),
      spacer(),
      twoColTable([
        ['22/06/2026 07:18', 'Admission via Emergency. VS: T 37, HR 100, BP 130/60, SpO2 98%, RR 20. Glucose 251 mg/dL. GCS 15. Started on Ringer Lactate IV + Mixtard 30 14 IU BD.'],
        ['22/06/2026 afternoon', 'Labs resulted. FBC normal. Biochemistry: Na 135, K 4.0, Cr 61, eGFR 94, AST 10, ALT 4. TSH critically suppressed at 0.0027. Abdominal USS: no acute findings.'],
        ['23/06/2026 08:00 (nursing)', 'HR 78, T 37, BP 120/60, SpO2 19/98% (corrected), BMI 55/21.5. Stable. Alert. Diet: 3 bowls of rice/day. Sleep 8 hrs. Bowels: normal, yellowish stools. Urine: clear/normal. Insulin dose increased to 16 IU BD. Sitagliptin added. Glucose monitoring twice daily.'],
        ['23/06/2026 09:06 (doctor note)', 'Hypoglycaemia risk: Low (YHHD: Thap). Diagnosis reconfirmed: T2DM uncontrolled; IHD; HTN; Dyslipidaemia; Hyperthyroidism. Drug orders updated per treatment sheet.']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 11 - DISCHARGE PLAN
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('XI.  ANTICIPATED DISCHARGE PLAN'),
      spacer(),
      bullet('Continue Mixtard 30 insulin (dose to be titrated at discharge based on inpatient glucose logs)'),
      bullet('Continue Metformin XR 750 mg once daily (evening)'),
      bullet('Continue Sitagliptin 50 mg once daily'),
      bullet('Consider GLP-1 RA (e.g., Semaglutide subcutaneous weekly) given IHD and poor glycaemic control - ADA 2026 strongly recommends GLP-1 RA with proven CV benefit for T2DM + ASCVD'),
      bullet('Continue Irbesartan 150 mg, Rosuvastatin 20 mg (consider uptitrating), Clopidogrel 75 mg'),
      bullet('Continue Thiamazole 10 mg daily; follow-up with endocrinology for hyperthyroidism management'),
      bullet('SMBG: Patient to check fasting and 2-hour post-prandial glucose daily; keep log'),
      bullet('Follow-up appointment: 2 weeks post-discharge at outpatient Endocrinology'),
      bullet('HbA1c recheck: 3 months'),
      bullet('Urine microalbumin/ACR: to be done at follow-up (not yet checked during this admission)'),
      bullet('Ophthalmology referral: Annual dilated fundoscopic exam'),
      bullet('Podiatry/Foot care: Footwear advice; monofilament test at next visit'),
      bullet('Thyroid ultrasound: As directed by endocrinology follow-up'),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // SECTION 12 - SIGNATURES
      // ══════════════════════════════════════════════════════════════════
      sectionHeader('XII.  SIGNATURES & DOCUMENTATION'),
      spacer(),
      twoColTable([
        ['Treating Doctor', 'BS. Cao Thi Minh  |  Signed 22/06/2026'],
        ['Duty Doctor (23/06)', 'Nguyen Ngoc Thuan  |  Signed 23/06/2026 08:19'],
        ['Nursing (22/06)', 'Dang Huu Thao Nhi  |  Signed 2026-06-22 10:58'],
        ['Nursing (23/06 AM)', 'Doan Thi Buoi  |  Signed 2026-06-23 09:58'],
        ['Nursing (23/06 PM)', 'Trinh Hoang Ngoc Thu  |  Signed 2026-06-23 18:40'],
        ['Lab Results Verified', 'CN. Sam Quoc Uy (KT Truong Khoa Xet Nghiem)  |  22/06/2026 13:22'],
        ['Ultrasound', 'BS CK1 Tran Huu Hang / BS Nguyen Thi Nhu Niem  |  22/06/2026'],
        ['Nurse educator signature', 'Per nursing care plan - all GDSK items documented']
      ]),
      spacer(),

      // ══════════════════════════════════════════════════════════════════
      // FOOTER NOTE
      // ══════════════════════════════════════════════════════════════════
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