CONTACTS 
0201 - Veterans Administration
020101 - Ms. Kathleen Clancy
020102 - Nurse Practioner; Primary Care Provider
020103 - Primary Care Center

SUBJECTS
Meeting Primary Care Physician VA Martinez CA Physical Examination R

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000. ref SDS 10 0000.
040502 -
040503 - Letti called and scheduled meeting with Kathy Clancy on 050629 1000,
040504 - reported on 050623. ref SDS 11 0001
040506 -  ..
040507 - Called this morning at 0810 to confirm Kathy is available....
040508 -
040509 -                     925 372 2000 ext 6344
040511 -  ..
040512 - Got answering machine.
040513 -
040514 -
040515 -
040516 -
040518 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 -
040902 - Checked in at 1000, and was given #22.  Service was currently at 14.
040903 -
040905 -  ..
0410 -
0411 -
0412 - 1012
0413 -
041301 - Got to #22.
041302 -
041303 - Kathleen Clancy had to go home for a family emergency.  Another
041304 - doctor agreed to see me, after he sees two other patients.
041305 -
041306 -
041307 -
0414 -

SUBJECTS
Vitals Blood Blood Pressure 117 75 Pulse 87 Temperature 97.1 Weight

0603 -
0604 - 1013
060501 -  ..
060502 - Vitals Taken to Prepare for Physical Examination
060503 -
060504 - Meeting with Teresa for new patient orientation.
060506 -  ..
060507 - Teresa took vitals...
060508 -
060509 -    Weight..................... 204
060511 -     ..
060512 -    Blood pressure............. 117 75
060514 -     ..
060515 -    Pulse...................... 87
060517 -     ..
060518 -    Temperature................ 97.1
060520 -  ..
060521 - Teresa said that the blood pressure is very good.  She said that
060522 - pulse at 87 is slightly above normal, which she said is 80.
060524 -  ..
060525 - She entered personal and family health history on prior medical
060526 - problems, drinking, smoking status.
060527 -
060528 -
060530 -  ..
0606 -
0607 -
0608 - 1032
0609 -
060901 - Teresa took me to an examination room, and asked me to wait for
060902 - Doctor Sandhu.  She called an administrator who said that customers
060903 - cannot use a computer while waiting to see a doctor.
060904 -
060905 -
060906 -
060907 -
060908 -
060909 -
0610 -

SUBJECTS
Physical Examination Annual Review Pending Issues Order Inital Basel

0803 -
0804 - 1047
080501 -  ..
080502 - Physical Examination Baseline Blood Tests
080503 -
080504 - Meeting with Doctor Sandhu.
080505 -
080506 - The doctor used a computer throughout the meeting as the primary
080507 - source for information and to organize conduct of the meeting.  He
080508 - made fairly extensive notes of the discussion, and indicated this is
080509 - the VA's online Medical Chart.
080511 -  ..
080512 - Agenda...
080513 -
080514 -        1.  Physical Examination
080515 -
080516 -            The doctor performed a standard clincial physical
080517 -            examination, including rectal cancer test.
080519 -             ..
080520 -            Vitals were taken earlier. ref SDS 0 0099
080522 -             ..
080523 -            The doctor recommended losing about 40 pounds.
080525 -             ..
080526 -            Stethoscope tested heart and lung function.
080528 -             ..
080529 -            Ear examination found no problems.
080530 -
080532 -             ..
080533 -        2.  Digestion - reported difficulty swallowing
080534 -            food, causing vomitting.
080536 -             ..
080537 -            Hiatal hernia - surgical solution is messy.
080539 -             ..
080540 -            Ordered an xray to investigate further for hiatal hernia.
080542 -             ..
080543 -            Doctor decided to try a regimen of pills taken 1.5 hours
080544 -            before eating.  This prescription will be issued at the
080545 -            next meeting after getting xrays.
080546 -
080547 -                [On 050706 chest xray delayed. ref SDS 12 KH6I
080548 -
080549 -                [On 050714 chest xray with barrium sulfate shows
080550 -                hiatical hernia, and constriction preventing digestion
080551 -                at the pylorus and duodenum. ref SDS 13 Q869
080553 -                 ..
080554 -                [On 050816 doctor mentions Achalasia as initial
080555 -                diagnosis, and research found an explanation that
080556 -                mentions "bird beak" like constriction of digestion
080557 -                system. ref SDS 15 DG97
080559 -                 ..
080560 -                [On 050830 received radiology report on barium imaging
080561 -                test performed today. ref SDS 17 UR3M
080563 -             ..
080564 -        3.  Neck blemish cancer mole, mellinoma
080565 -
080566 -            Says this is not a problem; indicated that a convex shape,
080567 -            with the blemish indented indicates a problem.  In this
080568 -            case the blemish is even with the surface, so he feels
080569 -            there is no problem.
080571 -             ..
080572 -            The doctor will have dermatology make an independent
080573 -            examination.
080574 -
080575 -                [On 050801 Doctor Gallacher concurred, nothing serious;
080576 -                schedule meeting on 050809 to remove the mole.
080577 -                ref SDS 14 DL8F
080578 -
080580 -             ..
080581 -        4.  Rosacia
080582 -
080583 -            The doctor will have dermatology make an independent
080584 -            examination.
080586 -             ..
080587 -        5.  Toes
080588 -
080589 -            No examination, no comments, although the meeting with
080590 -            dermatology might yield something.
080592 -             ..
080593 -        6.  Prostate examination by running a finger up the anal
080594 -            canal.
080596 -             ..
080597 -            Nothing noted nor discussed.
080598 -
080600 -             ..
080601 -        7.  Checked breathing with a stethascope for routine
080602 -            examination.  Nothing noted nor discussed.
080604 -             ..
080605 -        8.  Cholesterol
080606 -
080607 -            Doctor ordered LIPID test.
080608 -
080610 -  ..
080611 - The doctor submitted a
080612 -
080613 -                 Clinic Instruction
080614 -                 050629 1000
080616 -  ..
080617 - Primary Care Clinc lists names of attending physicians....
080619 -  ..
080620 - Kathleen's name is listed as "Clancy."
080622 -  ..
080623 - Doctor Sandhu's name is circled as.... "Sandhu."
080625 -  ..
080626 - The doctor entered vitals taken previously by Teresa, per above.
080627 - ref SDS 0 0099
080629 -  ..
080630 - On the back of the form, he checked...
080631 -
080632 -        After your appointment Today...
080634 -         ..
080635 -        Go to the Lab for tests.
080636 -
080637 -            This was performed. ref SDS 0 G69K
080639 -         ..
080640 -        Go to Radiology to schedule a test.
080641 -
080642 -            This was performed. ref SDS 0 GE7Q
080643 -
080644 -
080646 -  ..
080647 - Future Visits...
080649 -  ..
080650 - Lab:  No appoint or paperwork is needed.
080651 -
080652 -        Go to the Lab
080653 -
080654 -            There is illegible handwriting that says something will
080655 -            occur in a month, possibly related to the digestion issue,
080656 -            per above. ref SDS 0 G66V
080657 -
080659 -     ..
080660 -    The Lab tests ordered by your provider are...
080661 -
080662 -        Fasting - nothing but water and medications 12 - 14 hours
080663 -        before having the lab drawn.
080664 -
080665 -            This guidance appears conflicting...
080667 -             ..
080668 -            If this instruction is for the xray, then the guidance says
080669 -            not to eat or drink anything after midnight the night
080670 -            before the xray, per below. ref SDS 0 SO99
080672 -             ..
080673 -            Therefore, this might be for something else, but the
080674 -            purpose is not clear.
080675 -
080677 -  ..
080678 - Additonal Instructions:
080679 -
080680 -        Call after radiology test.
080681 -
080682 -
080683 -
080684 -
080686 -  ..
0807 -
0808 -
0809 - 1105
0810 -
081001 - Laboratory
081002 -
081003 -    Provided urine specimen
081005 -     ..
081006 -    Blood was drawn, about 6 vials.
081008 -     ..
081009 -    Presumably this is a new patient work up, since there was nothing
081010 -    mentioned in the meeting with the doctor about blood tests.
081011 -
081012 -        [On 050816 0830 lab results show WBC very high, so the doctor
081013 -        ordered follow up blood test, ref SDS 15 G540; blood draw
081014 -        performed same day. ref SDS 15 G544
081016 -         ..
081017 -        [On 050818 WBC still elevated; antibiotics prescribed, and
081018 -        follow up blood test. ref SDS 16 BM8O
081020 -         ..
081021 -        [On 050906 1204 another blood test to evaluate treatment for
081022 -        elevated WBC. ref SDS 18 DG8G
081024 -         ..
081025 -        [On 060505 doctor reports cholesterol was high in one or more
081026 -        of the blood tests a year earlier in 2005; orders follow up
081027 -        test, and may have ordered medication. ref SDS 19 MA6I
081029 -         ..
081030 -        [On 060623 0840 Teri reports results of lab show continued high
081031 -        cholesterol; doctor prescribes treatment with Lovastatin to
081032 -        reduce cholesterol. ref SDS 20 UO5N
081034 -         ..
081035 -        [On 090812 1030 Doctor orders another lab to test cholesterol
081036 -        and other factors that may explain sudden weight loss, besides
081037 -        improve fitness. ref SDS 21 NF4G
081039 -         ..
081040 -        [On 050906 1204 another blood test to evaluate treatment for
081041 -        elevated WBC. ref SDS 18 DG8G
081042 -
081043 -
081044 -
081045 -
081046 -
081048 -  ..
0811 -
0812 -
0813 - 1120
0814 -
081401 - Radiology Department.
081402 -
081403 - Scheduled meeting to take an xray on 050706 1030.
081405 -  ..
081406 - Received instructions for xray....
081407 -
081408 -    VA Northern California System of Clinics
081409 -    Martinez-Outpatient Clinic
081410 -    150 Muir Road
081411 -    Martinez, CA  94553
081413 -     ..
081414 -    Instructions for an Upper GI series (UGI)
081416 -     ..
081417 -    Report to Reception A - Diagnostic Radiology Service (Xray)
081418 -
081420 -
081421 -        Date of Exam..................... 050706 1030
081423 -     ..
081424 -    Instructions
081425 -
081426 -        Do not eat or drink anything after midnight the night before
081427 -        the exam.
081429 -         ..
081430 -        Bring your morning medications with you to take after the
081431 -        exam.
081433 -     ..
081434 -    The Examination
081435 -
081436 -        •  The xray tech will assist you and instruct you during the
081437 -           examination.
081439 -            ..
081440 -        •  During the exam you will be given barium to drink.  This
081441 -           barium will help the Radiologist by outlining the stomach
081442 -           and esophagus.  The radiologist will instruct you when to
081443 -           drink the barium while he/she is taking xrays.
081445 -            ..
081446 -        •  If you have any questions please inform the xray
081447 -           technologist or Radiologist.
081449 -            ..
081450 -        •  This examination will take approximately 1 hour.  In some
081451 -           cases delayed xrays are taken and the exam time is longer.
081453 -     ..
081454 -    The Report
081455 -
081456 -        After the examination has been completed and reviewed by the
081457 -        Radiologist, a report will be sent via computer to your
081458 -        physician and the medical records department.  If you are going
081459 -        to your physician after the exam, please inform the xray
081460 -        technologist.  the radilogy department will not release these
081461 -        records to the patient.
081463 -         ..
081464 -        If you are unable to make this appointment, please notify us
081465 -        as soon as possible so we can reschedule your examination.
081466 -        Thank you for helping us serve you better!
081468 -         ..
081469 -        Diagnostic Radiology Service
081471 -         ..
081472 -        925 372 2000 ext 5644 or 5790
081473 -
081475 -  ..
081476 - Received a reminder of a meeting.
081477 -
081478 -    VA Northern California Health Care System
081479 -    VA Outpatient Clinic Martinez
081480 -    150 Muir Road
081481 -    Martinez, CA  94553
081482 -
081484 -     ..
081485 -    June 25, 2005
081486 -    W0144
081488 -     ..
081494 -     ..
081495 -    This is a reminder of the following clinic appoint(s):
081496 -
081497 -        Wednesday July 6, 2005 1030 MTZ ANC RAD Special Procedures
081498 -        Clinic
081500 -     ..
081501 -    To cancel or reschedule please call 925 372 2000 ext 5644, Monday
081502 -    through Friday 0800 to 0430p, excluding holidays, so that another
081503 -    veteran may be provided care in yor place.  This will assist us in
081504 -    conserving resources and improving the quality of care for our
081505 -    patients.
081507 -     ..
081508 -    Please check in 15 minutes prior to your appointment at Reception
081509 -    Area A.  In order to keep our records current, please report any
081510 -    changes in your address, phone number or insurance to the clerk
081511 -    when you check in.
081513 -     ..
081514 -    Thank you for choosing VA as your health care provider.  We are
081515 -    committed to providing compassionate high-quality health care.  We
081516 -    welcome your comments and suggestions.
081517 -
081519 -  ..
081520 - Received schedule of meetings....
081521 -
081522 -    050706 1030  120 minutes MTZ ANC RAD Special Procedures
081523 -
081524 -    050801 1020  20 minutes MTZ MED Derm Galla
081526 -  ..
081527 - Turns out we have a meeting scheduled on 050706 1100 in San Francisco,
081528 - scheduled by Lyn on 050525. ref SDS 7 LQ6I  So, we cannot meet in
081529 - Martinez on the same day at 1030,
081530 -
081531 -
081533 -  ..
0816 -
0817 -
0818 - 1552
0819 -
081901 - Called Cindy at Steve's office and moved the meeting on 050706 to
081902 - 050707 1100.
081903 -
081904 -
081905 -
081906 -
081907 -
081908 -
081909 -
081910 -
081911 -
081912 -
0820 -