The patient is a 78 year old orange female who presents with multiple complaints. Chief complaint: immigration. Secondary complaints include Joe Biden, transgender people and the Clintons.

General: Patient is awake, but not woke. Patient is oriented to place and time but neither person nor event. Patient believes he is male despite recent executive orders and believes that Joe Biden is still the president of the United States.

Head: The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions, or scarring. Hair is of normal texture and evenly combed across the scalp to conceal male pattern baldness.

Eyes: Visual acuity is 20/20 without corrective lenses. Conjunctivae are clear without exudates or hemorrhage. Sclera is non-icteric. EOM are intact, PERRLA. Fundi appear normal including optic discs and vessels. No signs of nystagmus. Eyelids are normal in appearance without swelling or lesions. No soul is visible behind eyes.

Ears: The external ear and ear canal are non-tender and without swelling. The canal is clear without discharge. The tympanic membrane is normal in appearance with normal landmarks and cone of light. Hearing is intact with good acuity to whispered voice, particularly if you pretend to be his daughter and whisper dirty things. Patient will not allow physical examination of right ear.

Nose: Nasal mucosa is dry and irritated, consistent with signs of cocaine and inhalant abuse. The nasal septum is midline. Nares are patent bilaterally.

Throat: Oral mucosa is pink and moist with good dentition. Approximately one half of a McDonald's quarter pounder is lodged between incisors. Tongue normal in appearance without lesions and with good symmetrical movement. No buccal nodules or lesions are noted. The pharynx is normal in appearance without tonsillar swelling or exudates. There is an unusual amount of semen present in posterior oropharynx. Lab analysis confirms foreign DNA belongs to various Russian state officials.

Neck: The neck is supple without adenopathy. Trachea is midline. Thyroid gland is normal without masses. Carotid pulse 2+ bilaterally without bruit. No JVD. The gobbler is intact.

Cardiac: The external chest is normal in appearance without lifts, heaves, or thrills. PMI is not visible and cannot be palpated due to presence of excess truncal adipose tissue. Heart rate and rhythm are normal. No murmurs, gallops, or rubs are auscultated. S1 and S2 are heard and are of normal intensity despite millions of prayers.

Respiratory: The chest wall is symmetric and without deformity. No signs of trauma. Chest wall is non-tender. No signs of respiratory distress. Lung sounds are clear in all lobes bilaterally without rales, ronchi, or wheezes. Resonance is normal upon percussion of all lung fields. Unfortunately.

Abdominal: Abdomen is soft, symmetric, squishy, and non-tender without distention. There are no visible lesions or scars. The aorta is midline without bruit or visible pulsation. Umbilicus is midline without herniation. Bowel sounds are present and normoactive in all four quadrants and in patient's mouth. No masses, hepatomegaly, or splenomegaly are noted. Excessive abdominal fat.

Genital/Rectal: Rectal tone diminished, likely due to presence of foreign body in rectum as reported by patient. Seminal fluids are present in rectal canal. No external masses or lesions. Stool is normal in appearance and taste per patient's own reporting. guac negative.

External genitalia is normal in appearance without lesions, swelling, masses or tenderness. Vagina is pink and moist without lesions or discharge. Cervix is non-tender without lesions or erosions. Uterus is anteflexed, non-tender and normal in size. Ovaries are non-tender without palpable masses or enlargement.

Spine: not present upon evaluation.

Extremities: Upper and lower extremities are atraumatic in appearance without tenderness or degormity. +3 pitting edema bilaterally at ankles. Full range of motion is noted to all joints. Muscle strength is 5/5 bilaterally. Tendon function is normal. Capillary refill is less than 3 seconds in all extremities. Pulses palpable. Unsteady gait noted. Likely fall risk. Recommend use of ambulatory aids.

Neurological: Patient has trouble forming coherent thought. Motor function is normal with muscle strength 5/5 bilaterally to upper and lower extremities. Sensation is intact bilaterally. Reflexes 2+ bilaterally. Cranial nerves are intact. Cerebellar function is intact. Memory is normal and thought process is intact albeit stupid.

Psychiatric: Bizarre and unusual affect. Poor judgement and insight. Patient hallucinates Haitian ghosts and claims they will cook his pets. Patient meets SABU criteria (suicidal, homicidal and genocidal ideation concurrently).

All findings unremarkable and at patient's recorded baseline. Patient discharged to oval office in care of Peter Thiel.