CONTACTS 

SUBJECTS
Meeting Examination Primary Care Physician 3rd Review at Kaiser Trea

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 94 0000. ref SDS 84 0000.
140502 -
140503 - The primary care physician concurs with UCSF assessment that Millie
140504 - has responded to treatment for IBC with cetuximab. ref SDS 0 025H  CT
140505 - test on 070520 shows no evidence of metastatic cancer. ref SDS 0 EY5O
140506 - Findings appear conflicting with cancer marker rising 30%. ref SDS 0
140507 - GJ5M  Kaiser further concurs with UCSF recommendations to continue
140508 - treatment with cetuximab. ref SDS 0 7X6N  CT testing has not addressed
140509 - patient history of lung and heart disorders that are complications in
140510 - some cases with cetuximab. ref SDS 0 VM4N  Significant swings between
140511 - good news and new concerns stress emotions. ref SDS 0 Y642  Kaiser
140512 - requested that Millie coordinate with UCSF to provide blood test
140513 - results for continuing diagnostics tracking patients treated with the
140514 - clinical drug trial for bevacizumab (Avastin) and Taxol, which Millie
140515 - received in 2004 until discovery of pulmonary embolism forced Kaiser
140516 - to end this treatment. ref SDS 0 XO8N  Mild dizziness has begun to
140517 - occur again, which has been associated with enlarged right ventricle.
140518 - ref SDS 0 PT4K
140520 -         ..
140521 -        [On 070607 recurrent cellulitis diagnosed during examination at
140522 -        UCSF for treatment of IBC with cetuximab, ref SDS 96 8H3I;
140523 -        condition worsened during treatment in the Infusion Clinic,
140524 -        temperature over 102, ref SDS 96 8J37; UCSF treated Millie with
140525 -        ceftriaxone antibiotics, ref SDS 96 8J9R, cellulitis seemed to
140526 -        subside, and temperature dropped to 101.4, UCSF released Millie
140527 -        to go home, ref SDS 96 8J5C; Kaiser prescribed outpatient
140528 -        ceftriaxone antibiotics for 5 days. ref SDS 96 8L46
140530 -         ..
140531 -        [On 070625 CA 15-3 30 improved 30% for blood test on 070621
140532 -        aligns with clinical findings of IBC subsiding, indicating
140533 -        response to treatment with cetuximab alone. ref SDS 97 PD4N
140534 -
140535 -
140537 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Agenda Develop Work Plan Stage IV Breast Cancer 18 Mos after Mastectomy
140902 -
140903 - Follow up ref SDS 94 SM6M, ref SDS 79 SM6M.
140905 -  ..
140906 - This is the 17th physician meeting, and follows starting the 12th
140907 - cycle of chemotherapy since 060711, ref SDS 24 SM6M, to treat the 3rd
140908 - relapse of IBC. ref SDS 24 8Y8I  This is the 3rd meeting with the
140909 - primary care physician at Kaiser to review progress on referral to
140910 - UCSF for treatment through clinical study that began 070201.  Millie
140911 - met with the medical team at UCSF yesterday to start the 5th cycle of
140912 - cetuximab. ref SDS 94 0001  Background on Kaiser's referral is shown
140913 - in the record on 070105. ref SDS 46 PK68  The doctor had a hectic
140914 - schedule, and so the meeting scheduled to start at 1100 actually
140915 - started at 1122, as shown in the Medical Chart. ref SDS 0 I49O
140917 -  ..
140918 - Complete patient history of treatments for IBC 3rd relapse is reported
140919 - in the record of treatment at UCSF yesterday on 070524. ref SDS 95
140920 - PR8Q
140922 -  ..
140923 - Agenda for meeting at Kaiser on 070330 provides a structure for
140924 - planning the meeting today...
140925 -
140926 -    1.  CA 15-3 37 worsens............................. ref SDS 0 GJ5M
140927 -    2.  Lymphedema restricts exercise.................. ref SDS 0 4Y93
140928 -    3.  Breast exam IBC stable subsides................ ref SDS 0 025H
140929 -    4.  Side effects minimal........................... ref SDS 0 TQ6L
140930 -    5.  CT no distant metastasis, no test for PE....... ref SDS 0 EY5O
140931 -    6.  Patient work up continue strategy.............. ref SDS 0 K36G
140932 -    7.  Treatment plan weekly clinical trial........... ref SDS 0 7X6N
140933 -    8.  Pulmonary emboli how serious r ventricle....... ref SDS 0 CV5L
140934 -    9.  Dizziness mild recurrence...................... ref SDS 0 PT4K
140936 -  ..
140937 - Scheduled next meeting for Thursday 070725 1100, to review progress
140938 - treating IBC at UCSF on clinical study, and for general patient care,
140939 - as reported below. ref SDS 0 N96O
140940 -
140941 -
1410 -

SUBJECTS
Complex Patient History 45 Issues Overwhelms Span of Attention Drive

2303 -
230401 -  ..
230402 - Complex Patient History Knowledge Management Dilemma Issues Grow 45
230403 -
230404 - Follow up ref SDS 94 LU3J, ref SDS 84 LU3J.
230405 -
230406 - Sampling of issues patient history diagnosis and treatment...
230407 -
230408 -    1.  CA 15-3 monitors advance of cancer response to treatment
230409 -    2.  Lymphedema complicated by mastectomy surgery
230410 -    3.  Broken finger from minor fall complicates lymphedema
230411 -    4.  Esophagitis reflux digestion issues
230412 -    5.  Immune system chemotherapy increases risk of infection
230413 -        Chemotherapy increase risk of infection
230414 -    6.  Cat bites increase risk of infection complicates lymphedema
230415 -    7.  Pneumonia chemotherapy increases risk of infection
230416 -    8.  Metastatic cancer increases risk pulmonary embolism
230417 -    9.  Lymphadenopathy left axilla local regional metastasis
230418 -   10.  Lymphadenopathy right axilla distant metastasis
230419 -   11.  Lymphadenopathy left supraclavicular diagnose metastatic cancer
230420 -   12.  Breast cancer secondary IBC 3rd relapse left breast
230421 -   13.  Cancer mutates slow response chemotherapy treatment
230422 -   14.  Mastectomy surgery impact on treatment IBC relapse
230423 -   15.  Blood vessels removed mastectomy slow chemotherapy treatments
230424 -   16.  Treatment options, strategy, planning, schedule
230425 -   17.  Drug trials increase declining pool chemotherapy agents
230426 -   18.  UCSF Doctor Benz 2nd opinion apply diagnosis and treatment
230427 -   19.  Pulmonary embolism blood clots in lungs
230428 -   20.  INR weekly adjustments Coumadin treatment blood clots
230429 -   21.  Enlarged right ventricle heart problem Cor Pulmonale
230430 -   22.  Dizziness symptom enlarged right ventricle Cor Pulmonale
230431 -   23.  Fatigue shortness breath side effect chemotherapy loss fitness
230432 -   24.  Fatigue shortness breath symptom pulmonary embolism
230433 -   25.  Shortness breath fatigue dizzy symptoms pulmonary embolism
230434 -   26.  Coagulapathy hypercoagulable state work up genetic risks
230435 -   27.  Testing resolution of errors (see Benz 2nd opinion 060821)
230436 -   28.  Testing distant metastatic disease
230437 -   29.  Testing pulmonary embolism and heart disease
230438 -   30.  Communication hectic schedule not enough time to manage details
230439 -   31.  Emotional stress and well being
230440 -   32.  Cellulitis inflammation temperature 102.6 on chemotherapy
230441 -   33.  Urinary tract bladder infection
230442 -   34.  IBC rash spreads to right breast
230443 -   35.  Right breast rash may be "ring" infection, not cancer
230444 -   36.  Lung cancer seems to be diagnosed in the Medical Chart
230445 -   37.  IBC rash spreads to stomach and toward back
230446 -   38.  IBC rash spreads to left arm
230447 -   39.  Dry skin face chest arm
230448 -   40.  Right arm evidence light red rash, may be IBC spreading
230449 -   41.  Rash right upper right chest near port catheter
230450 -   42.  Restless legs side effect Benadryl pre-treatment
230451 -   43.  Sleeping difficulty side effect cetuximab
230452 -   44.  Rash intense .5" round rash about .75" above port catheter
230453 -   45.  Sleep nap after cetuximab treatments fatigue accumulating
230454 -
230455 -
2305 -

SUBJECTS
Vitals Blood Pressure Pulse Temperature SaO2 Weight Normal Low Anxie

3203 -
320401 -  ..
320402 - Vitals Show Stable Medical Condition with Slight Temp 99.4
320403 -
320404 - Follow up ref SDS 94 KB5L, ref SDS 84 KB5L.
320405 -
320406 - Elevated pulse at 69 reflects emotional trauma from coordinating the
320407 - work.
320408 -
320409 -     Conversion Celsius to Farhenheit...
320410 -
320411 -              http://www.wbuf.noaa.gov/tempfc.htm
320412 -
320413 -                     Blood
320414 -    Date   Time   Pressure  Pulse  Temperture  Weight So2
320415 -    .
320416 -    070525 1120..... 143  91     69   36.3c  97.40f         98
320417 -    070524 1235..... 134  75     61   36.6c  97.88f         99
320418 -    070524 1145..... 119  69     58   37.1c  98.78f         98
320419 -    070524   standing..........  67 ................
320420 -    070524 0945..... 132  80     56   37.0c  98.60f         98
320421 -    070517 1120..... 126  72     56   36.7c  98.06f        100
320422 -    070517 1020..... 140  75     54   36.6c  97.88f         98
320423 -    070517 0940..... 140  75     54   36.1c  96.98f         99
320424 -    070510 1145..... 145  86     54   35.9c  96.62f        100
320425 -    070510 1045..... 149  82     69   37.0c  98.60f         97
320426 -    070510 0900..... 132  75     62   36.8c  98.24f         99
320427 -    070503 1150..... 113  67     59   36.8c  98.24f         98
320428 -    070503 1055..... 125  72     54   36.1c  96.98f        100
320429 -    070503 0915..... 127  70     60   36.9c  98.42f         99
320430 -    070426 1130..... 119  70     57   36.3c  97.34f         96
320431 -    070426 1030..... 141  73     67   36.4c  97.52f         99
320432 -    070426 0900..... 130  78     52   36.5c  97.70f         97
320433 -    070419 1230..... 133  79     57   36.3c                 98
320434 -    070419 1130..... 141  78     56   37.6c                 99
320435 -    070419 0930..... 153  80     53   36.1c         147    100
320436 -    070330 1540..... 136  92     52   99.4          150     98
320437 -    070329 0900..... 141  76     60   36.6c                 99
320438 -    070301 1505..... 112  69     86   36.6c                 98
320439 -    070130 1300..... 140  83     87   98
320440 -    070105 1040.....
320441 -    061208 1226..... 152  90     76   97.8          147    99%
320442 -    061201 1430..... 123  76     76   97.5
320443 -    061110.......... 136  83     73   97.0          150    98%
320444 -    061020 1534..... 140  79     67   99.8          151    97
320445 -    060929 1452..... 141  78     66   98.3
320446 -    060908 1335..... 139  79     73   98.1
320447 -    060814 1610..... 139  80     59   98.2
320448 -    060808..........
320449 -    060711.......... 172  87     54   97.5          147
320450 -    060623.......... 141  87     71   98.0          147    99%
320451 -    060428.......... 129  73     80   99.4          149    99%
320453 -  ..
320454 - High blood pressure reflects pressure on patient worrying about
320455 - effectiveness of new treatment and arrangements between UCSF and
320456 - Kaiser for timely care, discussed on 070130, ref SDS 50 Y642, and
320457 - again on 070301. ref SDS 60 Y642
320459 -  ..
320460 - Today, Millie's vitals are mostly normal, similar to yesterday during
320461 - treatment at UCSF, ref SDS 95 AW4L, indicating reduced emotional
320462 - strain at this time, as discussed at UCSF on 070315, ref SDS 69 6A7J,
320463 - and again during examination yesterday ref SDS 94 Y642, and further
320464 - during the meeting today, per below. ref SDS 0 Y642
320465 -
320466 -
3205 -

SUBJECTS
Coordination Plan Communication Collaboration UCSF Kaiser Referral K

8503 -
850401 -  ..
850402 - Coordination Plan Divided Responsibilities Kaiser UCSF Referral
850403 - Collaboration Primary Care at Kaiser with UCSF Clinical Study Cetuximab
850404 -
850405 - Follow up ref SDS 94 S58J, ref SDS 84 2S4H.
850406 -
850407 - Coordination issues from complex referral arrangements are reviewed in
850408 - the record meeting at UCSF yesterday on 070524, ref SDS 94 S58J,
850409 - following up meeting at Kaiser on 070330. ref SDS 79 RM4G
850411 -  ..
850412 - Kaiser's policy position to analyze only 20% of data from CT tests,
850413 - and failure to assess progression of lung and heart disorders by
850414 - avoiding comparisons, for the purpose of saving time and money to
850415 - treat more patients, as presented in Kaiser's letter on 070517,
850416 - ref SDS 93 OS5G, obviates efforts to coordinate the work by the
850417 - patient, Kaiser, and UCSF over the past 3 months, which were requested
850418 - by Kaiser on 070202. ref SDS 54 T85K  Failure of team care, teamwork,
850419 - communication, and coordination were cited in national study on the
850420 - high cost of medical mistakes, reported 990912, ref SDS 2 0001, that
850421 - increase stress, discussed below. ref SDS 0 X74L
850423 -  ..
850424 - Kaiser's policy to reduce review when patient history requires
850425 - increased scrutiney impacts Millie's health care in a variety of
850426 - ways...
850427 -
850428 -        1.  Coordination........................... ref SDS 0 RM4G
850429 -        2.  Wicked problems........................ ref SDS 0 VF5M
850430 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
850431 -        4.  Emotional stress....................... ref SDS 0 X74L
850432 -        5.  Strategy risk management............... ref SDS 0 YL9I
850433 -        6.  Treatment approval..................... ref SDS 0 7X6N
850434 -        7.  Side effects assessment................ ref SDS 0 2C4L
850435 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
850437 -  ..
850438 - Difficulty coordinating patient history for referrals was presented in
850439 - a letter from UCSF on 070517. ref SDS 93 466H  This was illustrated on
850440 - 070511, when Kaiser ordered duplicate blood tests, ref SDS 90 T76M,
850441 - reviewed again at UCSF yesterday on 070524, ref SDS 94 4J7F, and
850442 - further considered in the medical chart, below. ref SDS 0 4T4G
850444 -  ..
850445 - Similar coordinating challenges occurred managing cancer marker data
850446 - on 070516. ref SDS 92 QN6M
850448 -  ..
850449 - On 070426 Millie received a letter via email notifying that Kaiser
850450 - received results on INR via telephone message from blood tests at
850451 - UCSF. ref SDS 86 TL5K  Kaiser further provided guidance on adjusting
850452 - Coumadin treatments for pulmonary embolism. ref SDS 86 4I8G  This was
850453 - a major improvement to efficiently coordinate the work, and corrected
850454 - prior practice communicating complex instructions through conversation
850455 - on the telephone proposed by Kaiser on 070307. ref SDS 65 UA3L  On
850456 - 070515 Millie received a printed letter through regular mail from
850457 - Kaiser advising that the blood test Kaiser ordered on 070511 was on a
850458 - Friday, and so getting INR results that day conflict with the schedule
850459 - and procedures in the Coagulation Control Clinic to send prescriptions
850460 - via email to patients on Friday in order to maintain continuity of
850461 - Coumadin essential for managing pulmonary embolism.
850462 -
850463 -
850464 -
850465 -
850466 -
850467 -
8505 -

SUBJECTS
CA 15-3 37 Blood Tests 070524 Cancer Marker Begins Rising Possible 4

9403 -
940401 -  ..
940402 - CA 15-3 Cancer Marker 37 UCSF and 56 Kaiser Increases 30%
940403 -
940404 - Follow up ref SDS 94 087J, ref SDS 84 087J.
940405 -
940406 - Millie had a blood test during treatment yesterday at UCSF; results
940407 - reported on 070531 show CA 15-3 37. ref SDS 95 A16M, increased 30%,
940408 - and align with impression from testing at Kaiser on 070511 that
940409 - reported CA 15-3 56, as shown in the record yesterday meeting with the
940410 - medical team at UCSF to consider approving Millie for another cycle of
940411 - treatment on the cetuximab clinical trial. ref SDS 94 087J
940412 -
940414 -  ..
9405 -
9406 -
9407 - Analysis
9408 -
940801 - Cancer Marker Reviewed with CT Test and Examination
940802 -
940803 - Follow up ref SDS 94 GJ5M, ref SDS 84 GJ5M.
940804 -
940805 - Cancer marker suddenly rising 30% after falling below the target level
940806 - of 31 at UCSF is reviewed in the record meeting with Doctor Rugo and
940807 - the medical team at UCSF yesterday, on 070524, including
940808 - correspondence from Kaiser, ref SDS 94 GJ5M, and correlations with
940809 - recent CT test on 070520. ref SDS 94 KJ90
940810 -
940811 -        [On 070625 CA 15-3 30 improved 30% for blood test on 070621
940812 -        aligns with clinical findings of IBC subsiding, indicating
940813 -        response to treatment with cetuximab alone. ref SDS 97 PD4N
940815 -  ..
940816 - Primary care physician concurred today with UCSF determination
940817 - yesterday on 070624 that treatment should continue with cetuximab
940818 - alone based on CA 15-3 testing in relation to CT test results and
940819 - physical examination, ref SDS 94 7X6N, and discussed further below.
940820 - ref SDS 0 7X6N  The medical chart does not address balancing benefits
940821 - of cetuximab against risks of heart and lung disorders, which have not
940822 - been evaluated for progression of disease. ref SDS 0 4F9O
940823 -
940824 -
940825 -
940826 -
9409 -

SUBJECTS
Lymphadenopathy Axillary No Findings Left Arm Patient No Complaint S

A303 -
A30401 -  ..
A30402 - Axillary Left Arm No Lymphadenopathy Lymphedema Prominent
A30403 - Lymphadenopathy Axillary Left Arm No Evidence Local Edema
A30404 -
A30405 - Follow up ref SDS 94 MW8J, ref SDS 84 MW8J.
A30406 -
A30407 - Patient has a long history of IBC on the left breast and associated
A30408 - lymphadenopathy in the left axillary, see case study on 040517.
A30409 - ref SDS 6 OW3I
A30411 -  ..
A30412 - Examination of the left axilla palpated no findings suggestive of
A30413 - Lymphadenopathy, and aligns with examination at UCSF yesterday on
A30414 - 070524. ref SDS 94 MW8J
A30416 -  ..
A30417 - The CT test on 070520 makes no findings of lymphadenopathy, shown in
A30418 - the record meeting at UCSF yesterday on 070524, ref SDS 94 B74K,
A30419 - though no indication the analyst actually looked at the left and right
A30420 - axillary, also, reported yesterday. ref SDS 76 VU6O
A30422 -  ..
A30423 - This record appears conflicting with new findings from CA 15-3 37
A30424 - showing 30% increase in cancer marker, per above. ref SDS 0 087J
A30425 -
A30426 -
A30427 -
A30428 -
A30429 -
A305 -

SUBJECTS
Lymphedema Swelling Persistent Left Arm Upper Intensity Subsides Ras

AM03 -
AM0401 -  ..
AM0402 - Lymphedema New Complications Elevated Rash Upper Left Arm
AM0403 - Swelling Rash Left Arm Lymphedema Complications Above Normal
AM0404 - Left Arm Lymphedema Cellulitis Complications Swelling Above Normal
AM0405 - Rash Lymphedema Complications Left Arm Swelling Above Normal
AM0406 -
AM0407 - Follow up ref SDS 94 4Y93, ref SDS 84 4Y93.
AM0408 -
AM0409 - Medical history of lymphedema in the left arm is reported in a case
AM0410 - study on 070130. ref SDS 50 VX6F
AM0412 -  ..
AM0413 - Like the meeting yesterday at UCSF, ref SDS 94 RV8O, there wasn't
AM0414 - enough time today to discuss correlations between exercise, to
AM0415 - strengthen the immune system that resists cancer, and relieves stress,
AM0416 - reviewed at UCSF on 070315, ref SDS 69 6A7J, but may compound
AM0417 - lymphedema with increased swelling, and complications of Cellulitis,
AM0418 - discussed at UCSF on 070222. ref SDS 58 GG4H  On 070330 cellulitis
AM0419 - was diagnosed,
AM0421 -  ..
AM0422 - The primary care physician observed the upper left arm shows reduced
AM0423 - rash, resolving prior findings of erratic inflammation during
AM0424 - examination at Kaiser on 070330. ref SDS 79 T87G  This was reported by
AM0425 - Millie on 070418. ref SDS 82 PZ3P and ref SDS 82 PZ7X, and aligns with
AM0426 - findings from the examination at UCSF yesterday. ref SDS 94 115F  The
AM0427 - patient has not experienced further erratic increases in red rash on
AM0428 - the left arm, since consideration of cetuximab side effects and/or
AM0429 - cellulitis on 070419. ref SDS 83 115F
AM0431 -  ..
AM0432 - The medical chart today reports rash minimal. ref SDS 0 1248
AM0434 -         ..
AM0435 -        [On 070607 recurrent cellulitis diagnosed during examination at
AM0436 -        UCSF for treatment of IBC with cetuximab, ref SDS 96 8H3I;
AM0437 -        condition worsened during treatment in the Infusion Clinic,
AM0438 -        temperature over 102, ref SDS 96 8J37; UCSF treated Millie with
AM0439 -        ceftriaxone antibiotics, ref SDS 96 8J9R, cellulitis seemed to
AM0440 -        subside, and temperature dropped to 101.4, UCSF released Millie
AM0441 -        to go home, ref SDS 96 8J5C; Kaiser prescribed outpatient
AM0442 -        ceftriaxone antibiotics for 5 days. ref SDS 96 8L46
AM0443 -
AM0444 -
AM0445 -
AM0446 -
AM0447 -
AM05 -

SUBJECTS
IBC Left Arm Examination Stable Subsides Rash Less Intense Conflicts

B103 -
B10401 -  ..
B10402 - IBC Left Arm Stable Subsiding Responds Treatment Cetuximab Drug Trial
B10403 - Left Arm IBC Stable Subsiding Responds Treatment Cetuximab Drug Trial
B10404 -
B10405 - Follow up ref SDS 94 527G, ref SDS 84 527G.
B10406 -
B10407 - The doctor was pleased IBC rash on the upper left arm seems much less
B10408 - intense and possibly less skin involvement than observed during
B10409 - examination at Kaiser on 070330, ref SDS 79 527G, when erratic
B10410 - inflammation from cellulitis and/or side effects of cetuximab
B10411 - treatments presented a severe condition, discussed above. ref SDS 0
B10412 - 3W6F
B10414 -  ..
B10415 - Reduced IBC rash observed today, aligns with examination at UCSF
B10416 - yesterday, and reporting CT test at Kaiser on 070520 found no evidence
B10417 - of metastatic disease. ref SDS 94 527G  This appears conflicting with
B10418 - CA 15-3 56 test at Kaiser on 070511, and CA 15-3 37 rising 30% in a
B10419 - test at UCSF yesterday on 070524. ref SDS 94 087J
B10421 -  ..
B10422 - The medical chart today reports rash minimal. ref SDS 0 1248
B10423 -
B10424 -
B10425 -
B10426 -
B105 -

SUBJECTS
Right Axillary Lymphadenopathy No Findings Right Arm Patient No Comp

BA03 -
BA0401 -  ..
BA0402 - Right Axillary Possible Involvement Red Rash Spreads Right Breast
BA0403 -
BA0404 - Follow up ref SDS 94 3D6K, ref SDS 84 3D6K.
BA0405 -
BA0406 - Background on patient history testing for lymphadenopathy in the right
BA0407 - axilla is reported in the record on 060929. ref SDS 30 3D6K
BA0409 -  ..
BA0410 - Examination of the right axillary aligned with review yesterday at
BA0411 - UCSF, which yielded found no evidence of lymphadenopathy, as occurred
BA0412 - examining the left axilla, per above, ref SDS 0 I63O, including
BA0413 - alignment with CT test results, and evident conflict with CA 15-3
BA0414 - cancer marker rising 30%, also above. ref SDS 0 7C3G
BA0415 -
BA0416 -
BA0417 -
BA0418 -
BA05 -

SUBJECTS
Right Arm Examination Rash Slight Blemishes No Evidence IBC No Findi

BI03 -
BI0401 -  ..
BI0402 - IBC Right Arm New Minimal Red Rash Not Diagnosed IBC or Cellulitis
BI0403 -
BI0404 - Follow up ref SDS 94 H15M, ref SDS 84 H15M.
BI0405 -
BI0406 - Background is reported in the record meeting at UCSF yesterday on
BI0407 - 070524. ref SDS 94 H15M  Examination at Kaiser today yielded similar
BI0408 - results reported on 070524 finding no spread of IBC to the right arm,
BI0409 - and no other rash or side effects of cetuximab at this time.
BI0410 - ref SDS 94 5Y6M
BI0411 -
BI0412 -
BI0413 -
BI0414 -
BI0415 -
BI05 -

SUBJECTS
IBC Right Breast Examination Stable Subsides Rash Inflammation Less

BS03 -
BS0401 -  ..
BS0402 - Right Breast Red Rash Spreads Possible Involvement Right Axillary
BS0403 - Red Rash Right Breast Spreads Possible Involvement Right Axillary
BS0404 -
BS0405 - Follow up ref SDS 94 W58J, ref SDS 84 W58J.
BS0407 -  ..
BS0408 - On 061204 IBC inflammation spread from the left chest area infected
BS0409 - with IBC across the sternum and slightly onto the right breast.
BS0410 - ref SDS 39 AE5I
BS0412 -  ..
BS0413 - The doctor concurred with examination yesterday at UCSF on 070524
BS0414 - finding reduced IBC rash, which aligns with CT test on 070520 that
BS0415 - found no evidence of metastatic disease; there is also possible
BS0416 - conflict with CA 15-3 37 rising 30%. ref SDS 94 613F
BS0418 -  ..
BS0419 - The medical chart today reports rash minimal, ref SDS 0 1248, and
BS0420 - that...
BS0422 -             ..
BS0423 -            Chest wall: decreased erythema on lower left chest wall and
BS0424 -            around her back. ref SDS 0 ZL5W
BS0425 -
BS0426 -
BS0427 -
BS0428 -
BS05 -

SUBJECTS
Rash Chest Right Side Above Breast Below Collar Bone Above Port Cath

C303 -
C30401 -  ..
C30402 - Right Chest Rash Not Visible Above Breast and Port Catheter
C30403 - Rash Above Port Catheter on Right Upper Chest Not Visible Today
C30404 -
C30405 - Follow up ref SDS 94 583G, ref SDS 84 583G.
C30406 -
C30407 - Background is reported on 070330. ref SDS 79 583G
C30409 -  ..
C30410 - This issue was resolved at that time on 070330, and has not recurred,
C30411 - noted during the meeting at UCSF yesterday on 070524. ref SDS 94 583G
C30412 -
C30413 -
C30414 -
C30415 -
C30416 -
C305 -

SUBJECTS
Left Supraclavicular Examination Palpation Neck Lymphadenopathy No F

CB03 -
CB0401 -  ..
CB0402 - Left Supraclavicular Examination PET Test Report Finding SUV 4.5
CB0403 - Prognosis Stage IV Metastatic Disease Relapse IBC Seems Likely
CB0404 - Lumps in Neck Reported 040309 Establish Stage IV Metastatic Cancer
CB0405 -
CB0406 - Follow up ref SDS 94 8R6M, ref SDS 84 8R6M.
CB0407 -
CB0408 - Background is reported on 070130 meeting with Doctor Rugo at UCSF.
CB0409 - ref SDS 50 8R6M
CB0411 -  ..
CB0412 - Like the left and right axillary locations, examination today for
CB0413 - cancer in left supraclavicular region found no evidence of lumps or
CB0414 - other indications of lymphadenopathy, as reported above. ref SDS 0
CB0415 - I63O  This aligns with examination yesterday at UCSF, including
CB0416 - correlation with favorable CT test on 070520 reporting impresion of no
CB0417 - metastatic disease, and that CA 15-3 37 cancer marker rising 30%
CB0418 - appears conflicting. ref SDS 94 A73N
CB0419 -
CB0420 -
CB0421 -
CB0422 -
CB05 -

SUBJECTS
IBC Left Breast Examination Stable No New Sites Rash Intensity Susid

CT03 -
CT0401 -  ..
CT0402 - 2 Scenarios IBC Subsides Conflicts CA 15-3 37 Cancer Marker Rises 30%
CT0403 - IBC Rash Left Breast Stomach and Back Seems to Be Subsiding
CT0404 - Examination IBC Rash Subsiding Responding to Treatment Cetuximab
CT0405 - Cetuximab Effective Treatment IBC Subsiding Left Breast Stomach Back
CT0406 -
CT0407 - Follow up ref SDS 94 025H, ref SDS 84 025H.
CT0408 -
CT0409 - Left chest presents the primary IBC disease site.  Recent patient
CT0410 - history on this issue with case studies is presented in examination at
CT0411 - UCSF on 070329. ref SDS 76 025H  All case studies with lessons learned
CT0412 - are listed on 061018. ref SDS 32 0001
CT0414 -  ..
CT0415 - Examination found IBC rash subsiding on the left chest.  The medical
CT0416 - chart reports impression "rash minimal," ref SDS 0 1248, and
CT0417 -
CT0418 -            Chest wall: decreased erythema on lower left chest wall and
CT0419 -            around her back. ref SDS 0 ZL5W
CT0421 -  ..
CT0422 - This substantially aligns with findings of subsiding IBC from
CT0423 - examination at UCSF yesterday on 070524. ref SDS 94 M68J  Decreased
CT0424 - IBC rash aligns with CT test on 070520; appears conflicting with CA
CT0425 - 15-3 cancer marker rising 30%, also, reviewed yesterday. ref SDS 94
CT0426 - EZ4G
CT0428 -  ..
CT0429 - The doctor was very pleased today that Millie has responded well to
CT0430 - treatment of IBC with cetuximab alone, has minimal side effects, and
CT0431 - has increased energy and vitality living daily life. per below,
CT0432 - ref SDS 0 TQ6L
CT0433 -
CT0434 -
CT0435 -
CT05 -

SUBJECTS
Prognosis Stable Subsiding IBC Rash Conflicts Rising CA 15-3 37 Canc

D103 -
D10401 -  ..
D10402 - Prognosis Good IBC Stable Cetuximab Clinical Study
D10403 - Stable Low Intensity IBC Rash Very Good Response to Treatment
D10404 - Cetuximab Prognosis Good Chance IBC Rash 3rd Relapse Will Clear Up Again
D10405 -
D10406 - Follow up ref SDS 94 M645, ref SDS 84 M645.
D10407 -
D10408 - The primary care physician concurs with favorable prognosis presented
D10409 - during examination yesterday on 070524 at UCSF, ref SDS 94 M645, and
D10410 - recommends continuing with the cetuximab clinical trial to treat IBC
D10411 - based on favorable CT test reviewed at UCSF yesterday, ref SDS 94
D10412 - TV7N, and examination showing IBC seems to be subsiding with minimal
D10413 - rash, per above. ref SDS 0 RT8L  CA 15-3 37 rising 30% does not
D10414 - support changing treatment at this time, also, proposed at UCSF
D10415 - yesterday. ref SDS 94 F13K  Medical chart shows treatment plan to
D10416 - continue cetuximab. ref SDS 0 125V
D10417 -
D10418 -
D105 -

SUBJECTS
Wicked Problems Complex Compound Issues Policy Conflicts Medical Tes

E803 -
E80401 -  ..
E80402 - Wicked Problems Increased Scrutiney Discover Correlations Implications
E80403 - Comparison Shows Progesssion Disease Discover Complex Wicked Problems
E80404 - Unnecessary Overkill Evaluate Progression Disease Comparison CT Tests
E80405 - Scrutiney Increased to Discover Wicked Complex Difficult Problems
E80406 -
E80407 - Follow up ref SDS 94 VF5M, ref SDS 84 VF5M.
E80408 -
E80409 - Wicked problems were reviewed yesterday at UCSF on 070524, ref SDS 94
E80410 - VF5M, citing research on 060722. ref SDS 26 346F  On 041005 Kaiser
E80411 - told Millie not to worry about rising symptoms and reports of patients
E80412 - dying from treatment with bevacizumab (Avastin), ref SDS 7 OG5L, since
E80413 - Millie's CT tests showed no problems. ref SDS 7 OG3I  Doctor Benz
E80414 - offered a second opinion on 041018 that correlations and nuance of
E80415 - complex problems with life-threatening implications are missed by
E80416 - typical CT tests.  Patients at high risk need increased scrutiney.
E80417 - ref SDS 8 588O  A few weeks later on 041104 testing performed ahead of
E80418 - schedule diagnosed pulmonary emoblism, which causes death. ref SDS 10
E80419 - RZ4I  Kaiser immediately removed Millie from the bevacizumab drug
E80420 - trial, despite having been effective treating her cancer, ref SDS 10
E80421 - N455, and did not find a replacement chemotherapy for two (2) months.
E80422 - Millie suddenly had a lot to worry about, as her cancer marker rose
E80423 - 300%, and progression of lung and heart and disorders was unknown.
E80425 -  ..
E80426 - On 041230, worry was relieved when Kaiser reported a follow up CT test
E80427 - showed that previous pulmonary embolism was no longer visualized,
E80428 - ref SDS 12 PW3K, and Kaiser scheduled Millie to resume treatment for
E80429 - cancer, which had been stopped on 041104. ref SDS 12 XQ41
E80431 -  ..
E80432 - On 061020 Kaiser disclosed that tests for pulmonary embolism use 1 MM
E80433 - thin slice spiral CT scans, rather than 5 MM scans that test for
E80434 - cancer. ref SDS 33 S56G  Testing only 20% of the data does not meet
E80435 - requirements for increased scrutiney of lung and heart disorders cited
E80436 - at UCSF on 041018. ref SDS 8 588O  Millie's high risks for pulmoanry
E80437 - embolism and enlarged right ventricle from treatment with cetuximab on
E80438 - clinical study were reviewed by Kaiser and UCSF on 061230. ref SDS 43
E80439 - PN6R  On 070116 UCSF disclosed cetuximab presents increased risks of
E80440 - lung and heart disorders, ref SDS 48 I75I, similar to bevacizumab in
E80441 - 2004.  On 070130 UCSF planned increased scrutiney, ref SDS 50 456H, to
E80442 - assess progression of lung and heart disorders. ref SDS 50 R16N  A few
E80443 - days later on 070202, the primary care physician confirmed that Kaiser
E80444 - planned to coordinate with UCSF on increased scrutiney to reduce risks
E80445 - of lung and heart disorders by using thin slice spiral CT testing to
E80446 - monitor progression of pulmonary embolism and enlarged right ventricle
E80447 - from treatment with cetuximab. ref SDS 54 T85K
E80449 -  ..
E80450 - On 070330 failure to implement planning for comparisons to assess
E80451 - progression of pulmonary embolism and enlarged right ventricle showed
E80452 - failure of Imaging Department at Kaiser to follow doctor's orders,
E80453 - ref SDS 79 B74K, indicated by case study on 061012. ref SDS 31 A55J
E80455 -  ..
E80456 - On 070517 Kaiser disclosed that all CT tests use 1 mm thin slice
E80457 - spiral technology, and policy position to ignore patient history that
E80458 - requires increased scrutiney by reviewing only 20% of test data, and
E80459 - failure to perform comparisons for evaluating progression of lung and
E80460 - heart disorders that are documented side effects of cetuximab
E80461 - treatments. ref SDS 93 OS5G
E80463 -  ..
E80464 - Failure of medical imaging to implement doctor's orders on test scope,
E80465 - and policy to reduce scrutiney when patient requires increased review
E80466 - for progression of lung and heart disorders presents several wicked
E80467 - problems...
E80468 -
E80469 -        1.  Coordination........................... ref SDS 0 RM4G
E80470 -        2.  Wicked problems........................ ref SDS 0 VF5M
E80471 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
E80472 -        4.  Emotional stress....................... ref SDS 0 X74L
E80473 -        5.  Strategy risk management............... ref SDS 0 YL9I
E80474 -        6.  Treatment approval..................... ref SDS 0 7X6N
E80475 -        7.  Side effects assessment................ ref SDS 0 2C4L
E80476 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
E80477 -
E80478 -
E80479 -
E80480 -
E80481 -
E80482 -
E80483 -
E80484 -
E805 -

SUBJECTS
Lung Cancer No Discussion Metastatic Disease Nodes Doctor's Progress

EK03 -
EK0401 -  ..
EK0402 - Lung Cancer Lymph Nodes Doctor's Progress Notes Medical Chart
EK0403 - Metastatic Cancer Lung Lymph Node Progress Notes Medical Chart
EK0404 -
EK0405 - Follow up ref SDS 94 G25K, ref SDS 84 G25K.
EK0406 -
EK0407 - Background is reported on 070130 in the record meeting with Doctor
EK0408 - Rugo at UCSF. ref SDS 50 G25K
EK0410 -  ..
EK0411 - Findings of no "interstitial disease" in the most recent CT test on
EK0412 - 070520, and reviewed at UCSF yesterday on 070524, ref SDS 94 SP3F, do
EK0413 - not support concern about lung cancer orignially shown in Kaiser's
EK0414 - Medical Chart on 061208, ref SDS 40 G25K, and again today, per below.
EK0415 - ref SDS 0 1248
EK0417 -  ..
EK0418 - Interstitial lung disease is listed in the clincial study Consent
EK0419 - documents received from UCSF on 070116. ref SDS 48 0256
EK0420 -
EK0421 -
EK05 -

SUBJECTS
CT Test Distant Metastasis No Findings Lymphadenopathy Cancer CT Sca

F803 -
F80401 -  ..
F80402 - CT Test 070326 No Findings Metastatic Disease
F80403 -
F80404 - Follow up ref SDS 94 EY5O, ref SDS 84 EY5O.
F80405 -
F80406 - The doctor noted good news finding no evidence of distant metastasis
F80407 - from the CT test at Kaiser on 070520, reported in the record meeting
F80408 - at UCSF yesterday on 070524. ref SDS 94 EY5O  He feels that CT testing
F80409 - aligns with examination today, and yesterday at UCSF, showing IBC rash
F80410 - subsiding, per above, ref SDS 0 RT8L, and that CT scan results
F80411 - conflict with CA 15-3 37 rising 30%, per above, ref SDS 0 GJ5M, and
F80412 - discussed yesterday at UCSF on 070524. ref SDS 94 GJ5M
F80414 -  ..
F80415 - Kaiser's letter on 070517 presented policy to review only 20% of test
F80416 - data that saves time and money for helping other patients is not
F80417 - supported by standard of care, ref SDS 93 WX8I, and further ignores
F80418 - patient history showing Millie requires increased scrutiney due to
F80419 - lung and heart preconditions that are at risk from treatment with
F80420 - cetuximab, ref SDS 93 OS5G, as disclosed in clinical study consent
F80421 - documents received from UCSF on 070116. ref SDS 48 I75I  Kaiser's
F80422 - analysis of the CT test on 070520 fails to cite patient history, shown
F80423 - in the record meeting at UCSF yesterday on 070524, ref SDS 94 GH5L;
F80424 - and further fails to assess progression of pulmonary embolism and
F80425 - enlarged right ventrical from comparison with diagnosis in a CT test
F80426 - at Kaiser on 060930, also, reviewed at UCSF yesterday. ref SDS 94 0136
F80427 - Treatment with cetuximab was approved yesterday at UCSF, and today at
F80428 - Kaiser from analysing only 20% of test data to assess correlations,
F80429 - implications and nuance that show progression of lung and heart
F80430 - complications.  This record aligns with case study on 061012 showing
F80431 - the Imaging Department at Kaiser fails to perform doctor's orders for
F80432 - case management. ref SDS 31 A55J
F80434 -  ..
F80435 - Failure of medical imaging to implement doctor's orders on test scope,
F80436 - and policy to reduce scrutiney when patient requires increased review
F80437 - for progression of lung and heart disorders presents several wicked
F80438 - problems...
F80439 -
F80440 -        1.  Coordination........................... ref SDS 0 RM4G
F80441 -        2.  Wicked problems........................ ref SDS 0 VF5M
F80442 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
F80443 -        4.  Emotional stress....................... ref SDS 0 X74L
F80444 -        5.  Strategy risk management............... ref SDS 0 YL9I
F80445 -        6.  Treatment approval..................... ref SDS 0 7X6N
F80446 -        7.  Side effects assessment................ ref SDS 0 2C4L
F80447 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
F80448 -
F80449 -
F80450 -
F80451 -
F805 -

SUBJECTS
Emotional Trauma Stress Moderate Pulse Elevated Cancer Subsides Reli

FK03 -
FK0401 -  ..
FK0402 - Emotional Trauma Rising Falling Cancer Symptoms Risks Image Testing
FK0403 - Exercise Vigor Strength Engagement Ease Distress Living with Cancer
FK0404 - Behavior Medical Specialist (BMS) Emotional Counseling Not Effective
FK0405 -
FK0406 - Follow up ref SDS 94 Y642, ref SDS 84 Y642.
FK0407 -
FK0408 - Medical issues create an emotional roller coaster explained on 070105,
FK0409 - ref SDS 46 Y642, and reviewed on 070301. ref SDS 60 Y642  On 070315
FK0410 - UCSF nurse practitioner, Brigid, who handles most examinations for the
FK0411 - doctor, asked how Millie is coping emotionally with major changes in
FK0412 - patient assessment the past month? ref SDS 69 6A7J  Stress and trauma
FK0413 - are compounded with rising complexity of case history, listed above.
FK0414 - ref SDS 0 LU3J  Millie's letter to Kaiser on 070516 illustrate recent
FK0415 - swings in emotional state from changes in prognosis. ref SDS 92 ZJ9N
FK0417 -  ..
FK0418 - Millie's vitals taken before the meeting today are slightly elevated,
FK0419 - e.g., pulse above 60, per above, ref SDS 0 KB5L, higher than yesterday
FK0420 - reported in patient history for treatment at UCSF. ref SDS 95 AW4L
FK0422 -  ..
FK0423 - This issue is reviewed in the record meeting at UCSF yesterday on
FK0424 - 070524 to start the 6th cycle on the cetuximab clinical study.
FK0425 - ref SDS 94 XU6M
FK0427 -  ..
FK0428 - Sudden reversal of cancer marker rising 30%, per above, ref SDS 0
FK0429 - 087J, together with research on 070328 explaining biomarkers predict
FK0430 - the course of disease to guide treatment, ref SDS 75 0001, has been
FK0431 - assuaged by assurances from the medical team there is nothing to worry
FK0432 - about. ref SDS 0 YO6G
FK0434 -  ..
FK0435 - Similarly, sudden disclosure on 070517 by Kaiser after 6 months asking
FK0436 - the patient to help the doctor order review of lung and heart
FK0437 - disorders, that Kaiser policy prevents using test and review methods
FK0438 - that originally diagnosed pulmonary embolism and enlarged right
FK0439 - ventricle in order to save money for helping other patients,
FK0440 - ref SDS 93 OS5G, was also assuaged by assurances that there is nothing
FK0441 - to worry about because 6 patients at UCSF have had no problems,
FK0442 - ref SDS 89 KD5I, using methods that have never worked for Millie,
FK0443 - discussed at UCSF on 070510. ref SDS 89 HW5I
FK0445 -  ..
FK0446 - Kaiser's policy to reduce review when patient history requires
FK0447 - increased scrutiney impacts Millie's health care in a variety of
FK0448 - ways...
FK0449 -
FK0450 -        1.  Coordination........................... ref SDS 0 RM4G
FK0451 -        2.  Wicked problems........................ ref SDS 0 VF5M
FK0452 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
FK0453 -        4.  Emotional stress....................... ref SDS 0 X74L
FK0454 -        5.  Strategy risk management............... ref SDS 0 YL9I
FK0455 -        6.  Treatment approval..................... ref SDS 0 7X6N
FK0456 -        7.  Side effects assessment................ ref SDS 0 2C4L
FK0457 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
FK0458 -
FK0459 -
FK0460 -
FK0461 -
FK0462 -
FK05 -

SUBJECTS
Strategy Continue Planning on 070419 Distinguish IBC Progression fro

GJ03 -
GJ0401 -  ..
GJ0402 - Planning Case Management from Patient Profile Work Up
GJ0403 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
GJ0404 - Strategy Cetuximab Continued with Low ANC Expanding IBC Disease
GJ0405 -
GJ0406 - Follow up ref SDS 94 K36G, ref SDS 84 K36G.
GJ0407 -
GJ0408 - Background is reported on 070301. ref SDS 60 K36G  Coordination issues
GJ0409 - are presented above. ref SDS 0 RM4G
GJ0411 -  ..
GJ0412 - The primary care physician concurs with UCSF strategy to continue
GJ0413 - treatment with cetuximab only, and add carboplatin if metastatic
GJ0414 - disease progresses, ref SDS 94 X86J, as shown in the medical chart for
GJ0415 - today. ref SDS 0 125V
GJ0417 -  ..
GJ0418 - On 070517 Kaiser proposed strategy for saving time and money to treat
GJ0419 - other patients, ref SDS 93 KV3H, by relying on reduced methods which
GJ0420 - have not been effective for Millie to assess life threatening side
GJ0421 - effects of blood clots, pulmonary embolism, and enlarged right
GJ0422 - ventricle that can occur from treatments in the cetuximab clinical
GJ0423 - study, ref SDS 93 WX8I, and by reviewing only 20% of CT test data and
GJ0424 - failing to assess progression of lung and heart disease by failing to
GJ0425 - compare CT test on 070520 with prior test on 060930, per discussion of
GJ0426 - coordination above. ref SDS 0 HM5G
GJ0428 -  ..
GJ0429 - Kaiser's policy to reduce review when patient history requires
GJ0430 - increased scrutiney impacts Millie's health care in a variety of
GJ0431 - ways...
GJ0432 -
GJ0433 -        1.  Coordination........................... ref SDS 0 RM4G
GJ0434 -        2.  Wicked problems........................ ref SDS 0 VF5M
GJ0435 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
GJ0436 -        4.  Emotional stress....................... ref SDS 0 X74L
GJ0437 -        5.  Strategy risk management............... ref SDS 0 YL9I
GJ0438 -        6.  Treatment approval..................... ref SDS 0 7X6N
GJ0439 -        7.  Side effects assessment................ ref SDS 0 2C4L
GJ0440 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
GJ0441 -
GJ0442 -
GJ0443 -
GJ0444 -
GJ0445 -
GJ05 -

SUBJECTS
Treatment IBC 12th Cycle 3rd Relapse 5th Cycle 1st Treatment Chemoth

GP03 -
GP0401 -  ..
GP0402 - Treatment IBC 3rd Relapse Start 5th Cycle Cetuximab Clinical Study
GP0403 - Cetuximab 5th Cycle Treatment IBC 3rd Relapse Clinical Study UCSF
GP0404 -
GP0405 - Follow up ref SDS 94 7X6N, ref SDS 95 PF3O.
GP0406 -
GP0407 - Patient history of cetuximab treatments, and starting the 5th cycle is
GP0408 - listed in the record yesterday working with the Infusion Clinic at
GP0409 - UCSF. ref SDS 95 7T3H
GP0411 -  ..
GP0412 - The doctor applied Kaiser's strategy to save time and money, per
GP0413 - above, ref SDS 0 YL9I, to concur with UCSF approval yesterday on
GP0414 - 070524 for Millie to continue treatment for IBC with cetuximab alone,
GP0415 - based on CA 15-3 rising 30%, CT test showing no metastatic disease,
GP0416 - and physical examination showing response to treatment. ref SDS 94
GP0417 - L49O  The doctor feels risks of lung and heart disorders are managed
GP0418 - well enough with Kaiser's new policy reported on 070517 to test for
GP0419 - pulmonary embolism and enlarged right ventricle by examining 20% of
GP0420 - test data from 1 mm scans, and without comparison for progression of
GP0421 - disease discovered only by reviewing all of the test data on 060930,
GP0422 - ref SDS 93 OS5G, as noted in the medical chart today, ref SDS 0 125V,
GP0423 - and discussed above on CT testing. ref SDS 0 VM4N
GP0424 -
GP0425 -        [On 070625 CA 15-3 30 improved 30% for blood test on 070621
GP0426 -        aligns with clinical findings of IBC subsiding, indicating
GP0427 -        response to treatment with cetuximab alone. ref SDS 97 PD4N
GP0429 -  ..
GP0430 - Kaiser's policy to reduce review when patient history requires
GP0431 - increased scrutiney impacts Millie's health care in a variety of
GP0432 - ways...
GP0433 -
GP0434 -        1.  Coordination........................... ref SDS 0 RM4G
GP0435 -        2.  Wicked problems........................ ref SDS 0 VF5M
GP0436 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
GP0437 -        4.  Emotional stress....................... ref SDS 0 X74L
GP0438 -        5.  Strategy risk management............... ref SDS 0 YL9I
GP0439 -        6.  Treatment approval..................... ref SDS 0 7X6N
GP0440 -        7.  Side effects assessment................ ref SDS 0 2C4L
GP0441 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
GP0442 -
GP0443 -
GP0444 -
GP0445 -
GP05 -

SUBJECTS
Side Effects Cetuximab Acne-like Rash Face Dry Skin Face Chest Arms

H303 -
H30401 -  ..
H30402 - Side Effects Cetuximab Similar Symptoms Pulmonary Embolism
H30403 - Energy Strength Rising Minimal Side Effects Cetuximab Treatment
H30404 - Facial Skin Dryness New Side Effect Cetuximab Curel Lotion Prescribed
H30405 - Curel Lotion Prescribed Facial Skin Dryness New Side Effect Cetuximab
H30406 -
H30407 - Follow up ref SDS 94 TQ6L, ref SDS 84 TQ6L.
H30408 -
H30409 - Side effects of treatment are listed in the record receiving treatment
H30410 - today in the Infusion Clinic. ref SDS 95 QU8K
H30412 -  ..
H30413 - On 070516 Millie notified the primary care physician at Kaiser with a
H30414 - copy to UCSF that she feels well, and is training hard in the gym to
H30415 - maintain fitness, ref SDS 92 UH4S, and following up the letter to UCSF
H30416 - on 070418 with copy to Kaiser advising she cannot remember feeling
H30417 - better. ref SDS 82 PY6W
H30419 -  ..
H30420 - The doctor concurred with review at UCSF yesterday, ref SDS 94 LS8L,
H30421 - indicating no findings of IBC, nor any rash, or other indication of
H30422 - side effects from cetuximab, as discussed above. ref SDS 0 4Y93
H30424 -  ..
H30425 - The doctor commented again today on how well, fit, and healthy Millie
H30426 - looks, continuing favorable review on 070330, ref SDS 79 N49K, echoing
H30427 - favorable assessment during the meeting at UCSF yesterday with the
H30428 - medical team in the Breast Care Center, ref SDS 94 TQ6L; and presented
H30429 - again in Nurse's Notes for treatment in the Infusion Clinic, also,
H30430 - yesterday on 070524. ref SDS 95 QU8K
H30432 -  ..
H30433 - Good health reflects renewed energy that enables returning to the gym
H30434 - for regular exercise, reported on 070218, ref SDS 57 N05H, and cited
H30435 - in case study on exercise issue. ref SDS 57 OB8H
H30437 -  ..
H30438 - On 070517 Kaiser notified Millie of policy change to avoid increased
H30439 - scrutiney with CT testing of complex, difficult problems and making
H30440 - mistakes diagnosing cetuximab side effects, which are actually
H30441 - complications of lung and heart disorders listed in Consent documents
H30442 - for clinical trial, blood clots in the lungs, pulmonary embolism,
H30443 - enlarged right ventricle, discussed in the record for meeting
H30444 - yesterday at UCSF. ref SDS 94 NY6N  Wicked problems in this case
H30445 - involve multiple subjects...
H30446 -
H30447 -        1.  Coordination........................... ref SDS 0 RM4G
H30448 -        2.  Wicked problems........................ ref SDS 0 VF5M
H30449 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
H30450 -        4.  Emotional stress....................... ref SDS 0 X74L
H30451 -        5.  Strategy risk management............... ref SDS 0 YL9I
H30452 -        6.  Treatment approval..................... ref SDS 0 7X6N
H30453 -        7.  Side effects assessment................ ref SDS 0 2C4L
H30454 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
H30455 -
H30456 -
H30457 -
H30458 -
H30459 -
H30460 -
H305 -

SUBJECTS
Cetuximab Clinical Study Kaiser Drug Trial Clinical Examination IBC

HA03 -
HA0401 -  ..
HA0402 - Cetuximab UCSF Clinical Study Treatment Begins 070201
HA0403 - Clinical Study UCSF Treatment Cetuximab Drug Trial Begins 070201
HA0404 - Drug Trials UCSF Has Other Clinical Study Treatments May Help Millie
HA0405 -
HA0406 - Follow up ref SDS 94 ZJ9N, ref SDS 84 ZJ9N.
HA0407 -
HA0408 - Background on Kaiser referral to UCSF for treatment on clinical study
HA0409 - is reported on 070105. ref SDS 46 P256  Purpose of referral is to
HA0410 - improve patient care with new treatment. ref SDS 46 PK7L  Case study
HA0411 - on Kaiser and UCSF collaborating to expedite treatment is listed on
HA0412 - 070130, ref SDS 50 4T5N, and reviewed again at UCSF on 070329,
HA0413 - ref SDS 76 RM4G, as further set out in the record for today, per
HA0414 - above. ref SDS 0 RM4G
HA0416 -  ..
HA0417 - Results of referral have been very good, with IBC rash subsiding at
HA0418 - all sites, and diagnostics improving shown by examination today, per
HA0419 - above, ref SDS 0 025H, and CT test on 070520 showing no findings of
HA0420 - metastatic disease, also reviewed above. ref SDS 0 EY5O  Recent cancer
HA0421 - biomarker CA 15-3 rising 30% may signal recovery with cetuximab alone
HA0422 - has ended, and needs to be boosted by adding carboplatin, planned by
HA0423 - Kaiser and UCSF, per strategy above. ref SDS 0 QQ8M
HA0425 -  ..
HA0426 - Millie feels and looks much better now, per above, ref SDS 0 025H,
HA0427 - than before starting treatment on 070201.
HA0428 -
HA0429 -
HA0430 -
HA0431 -
HA0432 -
HA05 -

SUBJECTS
Bevacizumab (Avastin) Taxol Clinical Study Drug Trial Follow Up Requ

HK03 -
HK0401 -  ..
HK0402 - Avastin Drug Trial Lab Blood Tests Request from UCSF
HK0403 - Bevacizumab (Avastin) Taxol Clinical Study Requires Lab Report
HK0404 -
HK0405 - Follow up ref SDS 10 RZ4I, ref SDS 7 0001.
HK0406 -
HK0407 - The doctor requested submission via email to the protocol nurse,
HK0408 - Rosalie, reports for recent blood tests performed by UCSF.  This is
HK0409 - part of the original commitment to get treatment with the clinical
HK0410 - study for bevacizumab (Avastin) and Taxol.  Treatments ended on 041104
HK0411 - with discovery that Millie had pulmonary embolism. ref SDS 10 RZ4I
HK0412 - Millie's last treatment with bevacizumab was on 041021. ref SDS 9 0001
HK0413 - Consent documents signed at Kaiser on 040402, ref SDS 4 966M, require
HK0414 - tracking patient medical condition for five (5) years. ref SDS 4 M145
HK0416 -  ..
HK0417 - Medical Chart Plan describes...
HK0419 -            ..
HK0420 -           Labs needed for E2100:  Bili, creat, CA 15-3, ALT, CBC
HK0421 -           w/diff, AST; email to Clinical Trial. ref SDS 0 125V
HK0422 -
HK0423 -
HK0424 -
HK0425 -
HK0426 -
HK05 -

SUBJECTS
Schedule Treatment Cetuximab 070524 Weekly Through 070802 Clinical S

HS03 -
HS0401 -  ..
HS0402 - Schedule Treatment Start Cetuximab Carboplatin 070201
HS0403 -
HS0404 - Follow up ref SDS 94 N96O, ref SDS 84 N96O.
HS0405 -
HS0406 - Scheduling and coordinating, per above, ref SDS 0 RM4G, present a
HS0407 - continuing challenge, reviewed on 070329. ref SDS 76 S63K
HS0409 -  ..
HS0410 - On 070510 Nola, the administrator for the Infusion Clinic at UCSF,
HS0411 - submitted a schedule for meetings with the medical team, and Millie's
HS0412 - treatments through 070802. ref SDS 89 QK6L
HS0414 -  ..
HS0415 - During the meeting today, the doctor scheduled the next meeting in
HS0416 - eight (8) weeks on 070720 1100 to assess treatment for IBC with the
HS0417 - cetuximab clinical study on referral to UCSF, as reported on 070202.
HS0418 - ref SDS 54 LX4I
HS0419 -
HS0420 -
HS0421 -
HS0422 -
HS0423 -
HS05 -

SUBJECTS
Pulmonary Embolism Blood Clots Lung Disorder Enlarged Right Ventricl

I603 -
I60401 -  ..
I60402 - Tired Breathing Difficulty Routine Activity Signals Pulmonary Emboli
I60403 - Coumadin Treatment Pulmonary Emboli Family History Genetic Cause
I60404 - Pulmonary Emboli Hypercoagulable Work Up PET Scan Test Compare History
I60405 -
I60406 - Follow up ref SDS 94 CV5L, ref SDS 84 CV5L.
I60407 -
I60408 - Background on pulmonary embolism and correlation with IBC treatment at
I60409 - UCSF is reported in the record meeting at UCSF on 070130. ref SDS 50
I60410 - CV5L  Doctor Rugo planned to avoid overlooking symptoms of pulmonary
I60411 - embolism that appear similar to side effects of chemotherapy
I60412 - treatment. ref SDS 50 MO7K  The plan called for a thin slice spiral CT
I60413 - test to evaluate cancer and to also check for pulmonary embolism.
I60414 - ref SDS 50 915J   The test at Kaiser the next day on 070131, failed to
I60415 - perform requirements for thin slice spiral CT testing, reported on
I60416 - 070202. ref SDS 54 TN6N
I60418 -  ..
I60419 - At that time, on 070202 the primary care physician at Kaiser planned
I60420 - to correct the problem by ordering thin slice spiral CT scan that
I60421 - tests for pulmonary embolism. ref SDS 54 P45O  The doctor requested a
I60422 - reminder to order the test for pulmonary embolism with Millie's next
I60423 - CT test on the clinical study at UCSF. ref SDS 54 T85K  On 070307 the
I60424 - doctor was reminded to order the test, as requested. ref SDS 65 9Z9N
I60426 -  ..
I60427 - Testing was performed on 070326.  Review on 070329 showed no reference
I60428 - to thin slice spiral CT, nor to comparison and findings on pulmonary
I60429 - embolism, and enlarged right ventricle, as commonly occurs when Kaiser
I60430 - tests for lung and heart disorders, shown by patient history listed on
I60431 - 070202. ref SDS 54 T85F
I60433 -  ..
I60434 - On 070330 Millie asked the primary care physician during a meeting at
I60435 - Kaiser if references to "interstitial disease" in the report for the
I60436 - CT test on 070326 indicate Kaiser followed the doctor's order planned
I60437 - on 070202 to evaluate progression of lung and heart disorders,
I60438 - ref SDS 54 P45O, but described the work differently from prior tests
I60439 - that present pulmonary embolism and enlarged right ventricle, shown in
I60440 - case study, also, on 070202? ref SDS 54 T85F  At that time on 070330,
I60441 - the doctor noted there is no evidence in the report for the CT test on
I60442 - 070326 that Kaiser evaluated pulmonary embolism and enlarged right
I60443 - ventricle, as shown in the record on 070329 reviewing Kaiser's test
I60444 - report. ref SDS 76 0136
I60446 -  ..
I60447 - On 070509 Millie requested support from UCSF coordinating work at
I60448 - Kaiser to assess progression of lung and heart disorders from side
I60449 - effects of cetuximab treatments at UCSF, ref SDS 88 3M6V, similar to
I60450 - UCSF support on 041018, ref SDS 8 LX96, that assisted Kaiser making
I60451 - the original diagnosis of pulmonary embolism reported on 041104.
I60452 - ref SDS 10 RZ4I  The next day, on 070510 UCSF advised that investing
I60453 - time to assist Kaiser evaluate risks of lung and heart disorders on
I60454 - the cetuximab study was unnecessary because 6 other patients did not
I60455 - require support. ref SDS 89 KD5I  After reviewing patient history of
I60456 - preconditions that were only discovered with support, ref SDS 89 HW5I,
I60457 - UCSF explained the coordinating work with Kaiser takes extra time and
I60458 - is stressful. ref SDS 89 TK8H
I60460 -  ..
I60461 - On 070514 Millie coordinated to align CT testing with requirements for
I60462 - evaluating preconditions of pulmonary embolism and Cor Pulmonale that
I60463 - can become complications from treatments on the cetuximab clinical
I60464 - study. ref SDS 91 IM9O  On 070517 the primary care physician disclosed
I60465 - that Kaiser analyses only 20% of test data scanned at 1 mm intervals,
I60466 - and explained that analysing data at 5 mm intervals, saves time and
I60467 - money for helping other patients, ref SDS 93 OS5G, even though this
I60468 - procedure has not helped Millie. ref SDS 93 WX8I
I60470 -  ..
I60471 - Kaiser performed the CT test on 070520; review at UCSF on 070524 shows
I60472 - Kaiser failed to consider patient history of pulmonary embolism and
I60473 - Cor Pulmonale (enlarged right ventricle), ref SDS 94 GH5L, despite
I60474 - notice on 061228 by the primary care physician that heart and lung
I60475 - disorders are closely related in Millie's case. ref SDS 42 0M6O
I60476 - Failure to recognize context of patient history of pulmonary embolism
I60477 - and enlarged right ventricle resulted in failure to compare the test
I60478 - on 070520 with the test on 060930 to assess progression of disease
I60479 - during treatment with cetuximab. ref SDS 94 0136
I60481 -  ..
I60482 - At this time, status of pulmonary embolism remains unknown.  Millie's
I60483 - energy has improved, indicating reduced risk; however, affirmative
I60484 - assessment with tests present better evidence than assumptions from
I60485 - absence of clinical symptoms, reviewed on 070517, ref SDS 93 H18K,
I60486 - especially for highly lethal conditions, like pulmonary embolism,
I60487 - where rising symptoms can be hidden by side effects and other benign
I60488 - maladies, reported on 060722. ref SDS 26 BI5J
I60490 -  ..
I60491 - Kaiser's policy to reduce review when patient history requires
I60492 - increased scrutiney impacts Millie's health care in a variety of
I60493 - ways...
I60494 -
I60495 -        1.  Coordination........................... ref SDS 0 RM4G
I60496 -        2.  Wicked problems........................ ref SDS 0 VF5M
I60497 -        3.  CT test scope history and comparison... ref SDS 0 VM4N
I60498 -        4.  Emotional stress....................... ref SDS 0 X74L
I60499 -        5.  Strategy risk management............... ref SDS 0 YL9I
I60500 -        6.  Treatment approval..................... ref SDS 0 7X6N
I60501 -        7.  Side effects assessment................ ref SDS 0 2C4L
I60502 -        8.  Pulmonary embolism..................... ref SDS 0 CV5L
I60503 -
I60505 -  ..
I60506 - INR 2.2 Blood Test Patient Stable for Coumadin Treatments Pulmonary Emboli
I60507 -
I60508 - Follow up ref SDS 94 FE9I, ref SDS 84 FE9I.
I60509 -
I60510 - The doctor was pleased that INR has remained stable since ending
I60511 - treatment with capecitabine (Xeloda) on 061201, and during treatment
I60512 - with cetuximab, shown in the blood test at UCSF yesterday on 070524,
I60513 - reported in the record getting treatment. ref SDS 95 SE6N  INR was
I60514 - also discussed with the medical team at UCSF on 070524. ref SDS 94
I60515 - FE9I
I60517 -  ..
I60518 - Communication issues are reviewed above on coordinating case
I60519 - management for coagulation control. ref SDS 0 Z13G
I60520 -
I60521 -
I60522 -
I60523 -
I606 -

SUBJECTS
Examination Stethoscope No Findings Enlarged Right Ventricle Heart S

IF03 -
IF0401 -  ..
IF0402 - Examination Breathing Stethoscope No Finding Enlarged Right Ventricle
IF0403 -
IF0404 - Follow up ref SDS 94 Q35O, ref SDS 84 Q35O.
IF0405 -
IF0406 - Examination with a stethoscope today included multiple locations on
IF0407 - Millie's back and chest.  The doctor reported no findings of cardio
IF0408 - pulmonary issues from clinical examination.  This method aligns with
IF0409 - the practice reported on 061020, ref SDS 33 PC6H, citing research on
IF0410 - 061012 about monitoring heart disorder of enlarged right ventricle,
IF0411 - Cor Pulmonale. ref SDS 31 IR5T
IF0413 -  ..
IF0414 - SaO2 diagnostic for oxygenated blood cited at Kaiser, on 061208,
IF0415 - ref SDS 40 1E5G, to indicate cardio-pulmonary functioning due to
IF0416 - pulmonary embolism, including enlarged right ventricle, was tested
IF0417 - three (3) times yesterday during treatment after examination, and was
IF0418 - consistently above 98%, demonstrating no immediate danger. ref SDS 95
IF0419 - AW4L  Vitals today showing Sa02 98% demonstrate continuing strong
IF0420 - cardio-pulmonary system. ref SDS 0 KB5L
IF0421 -
IF0422 -
IF0423 -
IF0424 -
IF05 -

SUBJECTS
Enlarged Right Ventricle Heart Disorder Cor Pulmonale Related Pulmon

IQ03 -
IQ0401 -  ..
IQ0402 - Cor Pulmonale Heart Disorder Enlarged Right Ventricle
IQ0403 - Heart Examination Not Ordered Investigate Enlarged Right Ventricle
IQ0404 - Enlarged Right Ventricle CT Test Aligns Patient Symptoms How Serious
IQ0405 -
IQ0406 - Follow up ref SDS 94 VJ4J, ref SDS 84 VJ4J.
IQ0407 -
IQ0408 - Background on heart disorder Cor Pulmonale from enlarged right
IQ0409 - ventricle, diagnosed on 061012, ref SDS 31 7E5L, and plans for CT
IQ0410 - testing is reported on 070130. ref SDS 50 VJ4J  Kaiser failed to
IQ0411 - perform review to evaluate enlarged right ventricle, reported above.
IQ0412 - ref SDS 0 5U7L
IQ0414 -  ..
IQ0415 - This issue is closely related to pulmonary embolism, reported by the
IQ0416 - primary care physician on 061228. ref SDS 42 JU7L  Subsiding symptoms
IQ0417 - for pulmonary embolism reported on 070301, ref SDS 60 SX6N, and again
IQ0418 - today signal Cor Pulmonale, also, seems under control, however, the
IQ0419 - actual status is unknown, per above. ref SDS 0 E44L
IQ0421 -  ..
IQ0422 - During the meeting today, the primary care physician did not make
IQ0423 - referral for examination by a heart specialist, nor to get a treadmill
IQ0424 - test, ref SDS 54 UN9F, discussed by Doctor Rugo during the meeting at
IQ0425 - UCSF on 070130. ref SDS 50 RV3O
IQ0426 -
IQ0427 -
IQ0428 -
IQ0429 -
IQ0430 -
IQ05 -

SUBJECTS
Dizziness Mild Recurrent from 060812 10 Seconds Getting Out of Bed S

J603 -
J60401 -  ..
J60402 - Dizziness Mild Symptoms Recur
J60403 -
J60404 - Follow up ref SDS 94 PT4K. ref SDS 28 PT4K.
J60405 -
J60406 - Millie reported today that mild dizziness lasting for 10 seconds or so
J60407 - getting out of bed in the morning has returned the past few weeks, as
J60408 - reported at UCSF yesterday on 070524, ref SDS 94 PT4K, and cited
J60409 - generally in the Medical Chart today, per below. ref SDS 0 1248
J60411 -  ..
J60412 - Mild dizziness getting up in the morning originally occurred on
J60413 - 060217, and was carefully reviewed at that time. ref SDS 22 PT4K
J60414 - Subsequently, on 061012 review of the CT test on 060930 showed
J60415 - diagnosis of enlarged right ventricle. ref SDS 31 7E5L  Research
J60416 - indicates that dizziness may be a symptom. ref SDS 31 IR46
J60418 -  ..
J60419 - Since prior problems subsided, at this time no further examination was
J60420 - made, and no treatment prescribed.
J60421 -
J60422 -
J60423 -
J605 -

SUBJECTS
Work Plan Doctor Submits Doctor/Patient Partnership Communications I

JX03 -
JX0401 -  ..
JX0402 - Work Plan Received Communications Doctor/Patient Partnership
JX0403 - Communications Doctor Submits Work Plan Doctor/Patient Partnership
JX0404 - Doctor/Patient Partnership Communications Doctor Submits Work Plan
JX0405 -
JX0406 - Follow up ref SDS 79 FE4I, ref SDS 47 FE4I.
JX0412 -  ..
JX0413 - Issues from Kaiser's Progress Notes continue from prior review on
JX0414 - 061110, ref SDS 29 EN4K, listed again on 061208, ref SDS 31 EN4K, and
JX0415 - again on 070330. ref SDS 79 BX5K
JX0417 -  ..
JX0418 - New issues include...
JX0419 -
JX0420 -    1.  Current medications correct prior errors ref SDS 79 SE86, by
JX0421 -        adding cetuximab begun on 070201. ref SDS 0 SE86
JX0423 -         ..
JX0424 -    2.  Progress Notes represent IBC expanded after mastectomy surgery
JX0425 -        on 051021, when this was not reported until 060623. ref SDS 79
JX0426 -        J58L
JX0428 -         ..
JX0429 -    3.  Pulmonary embolism reported in Progress Notes diagnosed in
JX0430 -        2004, ref SDS 0 J58L; but, Medical Chart fails to report
JX0431 -        recurrent PE diagnosed with CT test on 060930. ref SDS 0 J59N
JX0433 -         ..
JX0434 -    4.  Enlarged right ventricle heart disorder Cor Pulmonale
JX0435 -        complication pulmonary embolism has never been reported in the
JX0436 -        Medical Chart. ref SDS 79 LF5R
JX0438 -         ..
JX0439 -    5.  Progress Notes last sentence vague and incomplete, repeating
JX0440 -        language from prior report on 070330; presenting conditions as
JX0441 -        mere patient statements is misleading and incomplete.
JX0442 -        ref SDS 0 J59N
JX0444 -         ..
JX0445 -    6.  Physical examination corrects prior error by reporting IBC rash
JX0446 -        subsiding from treatment with cetuximab. ref SDS 0 ZL5W
JX0448 -         ..
JX0449 -        Physicial examination presents abreviations and shorthand tht
JX0450 -        are not defined in the record, and therefore appear vague and
JX0451 -        incomplete that increase risk of error.
JX0453 -         ..
JX0454 -    7.  Lab section is incomplete and erroneous listing only results of
JX0455 -        4 blood tests performed at Kaiser, and failing to list the date
JX0456 -        of tests for context, and further failing to disclose and
JX0457 -        report 100 blood tests performed at UCSF during the current
JX0458 -        reporting period. ref SDS 0 128S  Review on 070330 reported
JX0459 -        failure to notice lab results essential for continuity of care
JX0460 -        indicates requirements for coordination plan. ref SDS 79 4T4L
JX0462 -         ..
JX0463 -    8.  CT test on 070326 and the recent test on 070520 are reported in
JX0464 -        the medical chart correcting prior error in the Medical Chart.
JX0465 -        ref SDS 0 129Y
JX0467 -         ..
JX0468 -    9.  Medical Chart does not report failure of Imaging Department to
JX0469 -        perform comparisons that assess progression of disease.
JX0470 -        ref SDS 79 L14O
JX0472 -         ..
JX0473 -   10.  Medical Chart continues to omit 3 imaging tests between 060414
JX0474 -        and 060708. ref SDS 0 129Y
JX0476 -         ..
JX0477 -   11.  Imp section says "rash minimal" is vague and incomplete, since
JX0478 -        the patient has various types of rashes and different sites
JX0479 -        with multiple histories. ref SDS 0 1248
JX0481 -         ..
JX0482 -   12.  Imp section saying simply "dizziness" is vague and incomplete.
JX0483 -        ref SDS 0 1248
JX0485 -         ..
JX0486 -   13.  Plan to continue cetuximab treatment that has documented
JX0487 -        history of hear and lung complications, may conflict with
JX0488 -        failure to perform comparisons and report progresssion of
JX0489 -        preconditions for pulmonary embolism and enlarged right
JX0490 -        ventricle. ref SDS 0 125V
JX0492 -  ..
JX0493 - Progress continues toward good management using the doctor patient
JX0494 - partnership for timely review of patient history, called out in
JX0495 - Kaiser's Healthwise Handbook, reviewed on 990625, ref SDS 1 TD5S, and
JX0496 - reported on 060106. ref SDS 14 FE4I
JX0497 -
JX0498 -    1.  5/25/2007     11:22 PM
JX0499 -
JX0500 -            Wcr-ONnc2 > Main Campus
JX0503 -         ..
JX0504 -    2.  Your primary care clinician is listed as...
JX0505 -
JX0507 -
JX0906 -
JX0907 -
JX0908 -
JX0909 -
JX0910 -
JX0911 -
JX0912 -
JX0913 -
JX0914 -
JX0915 -
JX10 -