THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: March 7, 2008 10:47 AM Friday;
Millie submits labs and current medications to Kaiser to manage PE.
2...Labs Blood Tests INR Reported Kaiser Coagulation Control Department
3...Pulmonary Embolism Warfarin Coumadin Avoid Medication Conflicts
4...Coordination Kaiser Coagulation Control Department Coumadin for PE
5...Laboratory UCSF Report Submitted to Kaiser for Medical Chart
6...Medication Changes Evaluate Conflicts Adding New Treatments
7...Xray Shows No Evident Fracture or Injury Causing Pain to Right Arm
8...Referral Coordination Kaiser Commended
9...Commend Kaiser Timely Submission Test Report Ordering Medications
10...Kaiser Ordered Medications Prescribed by UCSF Timely Examination
11...Worry Blood Counts Problematic Starting Chemotherapy
........Medications Coagulation Control Department Notified
........Backup Medical Review Strengthens Health Care
........Referral Coordination Plan UCSF Relies Kaiser Backup Review
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1...Another issue is who checks all medications for conflicts?
Labs Blood Test 080306 Results INR 2.0 Submitted Kaiser Coalgulation
2003 - ..
2004 - Summary/Objective
200501 - Follow up ref SDS 18 0000. ref SDS 10 0000.
200503 - Coagulation Control Department at Kaiser in Martinez CA was notified
200504 - of results for blood tests on INR at UCSF yesterday, and for the
200505 - purpose of evaluating medication prescription of warfarin Coumadin to
200506 - treat pulmonary embolism. ref SDS 0 EX5H Kaiser was notified that
200507 - blood tests will be performed weekly; request guidance continue to
200508 - test INR and reported to Kaiser every 4 weeks. ref SDS 0 RW7Q Blood
200509 - test was also submitted to primary care physician at Kaiser for the
200510 - purpose of maintaining accurate patient history in the Medical Chart
200511 - on Kaiser's computer. ref SDS 0 JY5K Similarly, changes to medication
200512 - ordered by UCSF were submitted to correct omissions in Kaiser's
200513 - Medical Chart listing current medications. ref SDS 0 RW3T Request
200514 - Kaiser order new medications prescribed by UCSF. ref SDS 0 RW6X She
200515 - was able to get the medications at the Kaiser Park Shadelands
200516 - pharmacy. ref SDS 0 GN7F Kaiser submitted the xray taken on 080305.
200517 - It shows no evidence of injury to the right arm from the fall on
200518 - 080125. ref SDS 0 IT8N Millie wrote a letter to Kaiser thanking the
200519 - primary care physician for timely action submitting the xray report,
200520 - performing examination on short notice, and ordering medications
200521 - today. ref SDS 0 GZ4H Millie reports to Kaiser worry about
200522 - maintaining blood counts, which will prevent getting treatment at UCSF
200523 - for cancer. ref SDS 0 HS6R Millie further reported improvement
200524 - recovering from Cellulitis. ref SDS 0 HS6W Kaiser notified that UCSF
200525 - is relying on Kaiser examinations for backup 2nd opinons to strengthen
200526 - comprehensive care at UCSF. ref SDS 0 HT3U
200532 - ..
2008 - Progress
200901 - Labs Blood Tests INR Reported Kaiser Coagulation Control Department
200902 - Pulmonary Embolism Warfarin Coumadin Avoid Medication Conflicts
200903 - Coordination Kaiser Coagulation Control Department Coumadin for PE
200905 - Follow up ref SDS 18 EX5H.
200907 - Millie submitted ref DIT 1 0001 submitting blood test and current
200908 - medications to manage Coumadin treatments for pulmonary embolism.
200909 - This implements the letter to Kaiser on 080226 that planned submit
200910 - labs. ref SDS 18 S13U
200912 - 1. As planned in my letter to Kaiser on 080226, ref SDS 18 S13U,
200913 - there was another blood test at UCSF yesterday on 080306,
200914 - ref SDS 22 075H, to follow up the test on 080207, ref SDS 15
200915 - 075H, reported last week. ref DIT 1 0001
200917 - ..
200918 - 2. INR for yesterday was 2.0. ref SDS 22 PU7Y, ref DIT 1 WD5N
200920 - ..
200921 - 3. This is a bit anomalous compared to the past 6 months showing
200922 - INR generally between 2.3 - 2.7. ref SDS 22 JN8N, ref DIT 1
200923 - 3K6H
200925 - ..
200926 - May relate to Cellulitis and/or treatment with Keflex beginning on
200927 - 080304. ref SDS 19 106G
200929 - [On 080403 Millie submits INR results to Kaiser from the
200930 - next blood test at UCSF. ref SDS 29 K26H
200932 - ..
200933 - Millie's letter to Kaiser continues...
200935 - 4. Please note my understanding that going forward blood tests
200936 - will be performed weekly for the clinical trial study. Please
200937 - advise if this needs to include INR each week, every other
200938 - week, or to continue with monthly INR tests, as done the past
200939 - [year]. ref DIT 1 3K49
200941 - [On 080312 letter to UCSF reports Kaiser has not proposed
200942 - increasing INR testing, and discusses maintaining blood
200943 - tests for INR and CA 15-3 to reduce costs and level of
200944 - effort, since in the case of INR, testing has shown
200945 - consistent compliance with criteria for the past year.
200946 - ref SDS 23 RT7Q
Laboratory Blood Test 080306 UCSF Report Submitted to Kaiser for Med
430401 - ..
430402 - Laboratory UCSF Report Submitted to Kaiser for Medical Chart
430404 - Follow up ref SDS 20 417N.
430406 - Millie's letter to Kaiser continues...
430408 - 5. By copy providing the complete test [at UCSF on 080306] to the
430409 - primary care physician for incorporation into the medical
430410 - chart. ref SDS 22 439L, ref DIT 1 3K6M
430412 - ..
430413 - 6. Note that CA 15-3 is still in Lab. Results are typically
430414 - reported OA Tuesday. ref DIT 1 LS7M
430416 - ..
430417 - At this time, Kaiser's medical chart for the meeting on 080305 simply
430418 - says "Labs." There is no effective date and there is no statement
430419 - showing the source. ref SDS 20 417N
430421 - ..
430422 - Submitting the UCSF blood test enables Kaiser to add this record to
430423 - the medical chart, which solves the problem of incomplete and outdated
430424 - test data reported in the record on 080305. ref SDS 20 K85L
430426 - [On 080409 Millie treated in Kaiser Emergency Care
430427 - Department for recurrent Cellulitis; nurse reports blood
430428 - tests stable compared to prior testing in October 2007,
430429 - which was incorrect, because Kaiser's computer omits test
430430 - results performed for 6 months at UCSF on referral from
430431 - Kaiser. ref SDS 30 439L
430433 - ..
430434 - Referral coordination plan discussed at UCSF on 070222, ref SDS 2
430435 - WY6J, requires distribution of current, accurate laboratory blood test
430436 - reports prepared by UCSF for entering into the medical chart at Kaiser
430437 - in order for Kaiser to provide backup medical opinion which UCSF
430438 - reported yesterday has been relied upon by UCSF to enable
430439 - comprehensive care for Millie. ref SDS 21 JT3L
Medications Changes Coordination Notify Kaiser Coagulation Control D
710401 - ..
710402 - Medication Changes Evaluate Conflicts Adding New Treatments
710404 - Follow up ref SDS 20 7Y6F.
710406 - 7. Please note changes to medication. The medical chart listing
710407 - Current Medications from the meeting at Kaiser Wednesday,
710408 - 080305, ref SDS 20 7Y6F shows... ref DIT 1 3K7L
710410 - TIMOLOL MALEATE 0.5% EYE DR
710411 - WARFARIN 4MG TABLETS
710412 - ACYCLOVIR 800MG TABLETS
710413 - LORAZEPAM 1 MG TABLETS
710414 - ERBITUX
710416 - [...below, notified primary care physician of
710417 - notice to Coagulation Control Clinic that
710418 - prescribed medications have been significantly
710419 - changed. ref SDS 0 HT3P
710421 - ..
710422 - 8. To this list the primary care physician, ref DIT 1 PPUS, has
710423 - added...
710425 - Keflex........ 10 day treatment beginning on 080304
710426 - Prozac
710428 - ..
710429 - 9. This was reported during a meeting at Kaiser on 080305.
710430 - ref SDS 20 5L5M, ref DIT 1 PPUX
710432 - [On 080312 Millie notifies Kaiser that treatment
710433 - with Prozac was stopped after 2 treatments.
710434 - ref SDS 23 RT8Y
710436 - ..
710437 - 10. UCSF further added beginning on 080313...
710439 - Carboplatin
710440 - Compazine
710441 - Zofran
710443 - ...as reported during the meeting yesterday on 080306.
710444 - ref SDS 21 459G, ref DIT 1 AU9O
710446 - ..
710447 - This performs action item listed from the meeting at Kaiser on 080305.
710448 - ref SDS 20 IE6M
710450 - ..
710451 - Another issue is who checks all medications for conflicts?
710453 - ..
710454 - Letter to Kaiser continues...
710456 - 11. By copy to the doctor and to Arlette, alerting we need a
710457 - prescription for Compazine and Zofran. ref DIT 1 3K44
710459 - [...below letter to primary care physician commends
710460 - Kaiser's timely order for medications prescribed by
710461 - UCSF for Millie's treatment with Carboplatin
710462 - beginning next week. ref SDS 0 GZ4H
710464 - ..
710465 - Copy of this letter to primary care physician updating list of current
710466 - medications in the medical chart at Kaiser, which was incomplete
710467 - during the meeting on 080305. ref SDS 20 7Y6F
710471 - ..
7107 - 1542
710801 - Millie picked up medications prescribed by Brigid yesterday, per
710802 - letter to Kaiser asking the doctor to place the order. ref SDS 0 RW6X
Xray 080305 Right Arm Shoulder Evaluate Injury Fall 080125 Continuin
8304 - 1937
830501 - ..
830502 - Xray Shows No Evident Fracture or Injury Causing Pain to Right Arm
830504 - Follow up ref SDS 20 5M39.
830506 - Millie received ref DRT 1 0001 from the primary care physician at
830507 - Kaiser, and transmitting results of xray ordered on 080305 during
830508 - examination of the right arm by the doctor. At that time, Millie
830509 - complained of continuing pain for 6 weeks, ref SDS 20 5M39, since
830510 - falling on 080125. ref SDS 11 N65K
830512 - [On 080312 submitted results of xray report showing now
830513 - findings of fracture or trauma, to medical team at UCSF.
830514 - ref SDS 23 RT6S
830516 - ..
830517 - This record omits document identification for tests, shown by example
830518 - for CT test on 080215. ref SDS 16 DA6Q
830520 - ..
830521 - Generally, the test was performed at Kaiser Walnut Creek CA on 080305
830522 - OA 1330...
830524 - 1. RIGHT HUMERUS
830526 - 2. HISTORY
830528 - Trauma.
830530 - ..
830531 - 3. FINDINGS
830533 - No fracture is seen. Alignment is maintained. ref DRT 1 JF5O
830538 - ..
830539 - Finding no fracture and alignment maintained supports Doctor Malone's
830540 - examination in the Minor Injury Clinic on 080204. ref SDS 14 JQ8N
830542 - ..
830543 - On 080305 the doctor considering an MRI test if xray is negative, as
830544 - reported in findings today, and pain continues. ref SDS 20 5M4K
830546 - [On 080312 Millie reports continuing pain in right arm,
830547 - but now subsiding, and so MRI not needed at this time.
830548 - ref SDS 23 RU3S
Coordination Referral Commend Collaboration Communication Timely Sub
A00401 - ..
A00402 - Referral Coordination Kaiser Commended
A00403 - Commend Kaiser Timely Submission Test Report Ordering Medications
A00404 - Kaiser Ordered Medications Prescribed by UCSF Timely Examination
A00407 - ..
A00408 - Millie submitted ref DIT 2 0001 a letter to the primary care physician
A00409 - through Kaiser's Knowledge Management and medical management system,
A00410 - saying...
A00412 - 1. Thanks for submitting the xray report on Wedensday [ordered by
A00413 - the doctor on 080305, ref SDS 20 5M39, performed at Kaiser
A00414 - later on 080305, ref SDS 20 P14M, received today from the
A00415 - doctor, per above. ref SDS 0 IT8N], and for seeing me on short
A00416 - notice [on 080304 UCSF recommended same day examination of
A00417 - Cellulitis recurrence, ref SDS 19 5U8I; Kaiser scheduled
A00418 - examination for the next day on 080305 1200. ref SDS 20 QY5I]
A00419 - Thanks too for ordering the additional meds Doctor Rugo
A00420 - prescribed yesterday getting me ready to start carbo next week
A00421 - [implements request in Millie's letter to Kaiser earlier this
A00422 - morning, per above. ref SDS 0 RW5V] I picked them up earlier
A00423 - today. ref DIT 2 0001
A00425 - [On 080605 primary care physician terrific referral
A00426 - commended by surgery department for presenting patient
A00427 - history that enables productive meeting planning operation
A00428 - for Power Port. ref SDS 36 635W
Labs UCSF Blood Counts Worry Emotional Trauma NEUTS ANC Too Low Prev
AL0401 - ..
AL0402 - Worry Blood Counts Problematic Starting Chemotherapy
AL0404 - Follow up ref SDS 21 NW7K, ref SDS 17 1K4P.
AL0406 - 2. I'm worried if blood counts will hold up for weekly carbo [see
AL0407 - discussion on 080305, ref SDS 20 PC6M, and the letter to UCSF
AL0408 - on 080219, ref SDS 17 1K4P], but did you notice NEUTS was 2.75
AL0409 - [test on 080306 at UCSF, ref SDS 22 QY6H, and reported during
AL0410 - meeting with UCSF medical team. ref SDS 21 033B]. I think
AL0411 - that's ANC 2750. It has not been that high for 2 years, so I'm
AL0412 - grateful to be starting out with some cushion. ref DIT 2 Q45O
AL0414 - [On 080313 blood counts NEUTS 2.05 still high enough for
AL0415 - treatment. ref SDS 24 QY6H
AL0417 - ..
AL0418 - [On 080320 blood counts fall NEUTS 1.28. ref SDS 25 QY6H
AL0420 - ..
AL0421 - [On 080327 blood counts rise NEUTS 2.30, ref SDS 26 QY6H
AL0423 - ..
AL0424 - [On 080403 blood counts fall NEUTS 1.34, ref SDS 28 QY6H,
AL0425 - Neupogen prescribed to increase blood counts.
AL0427 - ..
AL0428 - [On 080403 UCSF prescribes Neupogen to increase blood
AL0429 - counts for safe weekly treatments with Carboplatin
AL0430 - chemotherapy added to cetuximab. ref SDS 27 I33G
AL0432 - ..
AL0433 - [On 080410 NEUTS 6.85 rise to highest ever after treatment
AL0434 - with Neupogen, and suffering Cellulitis and lymphedema
AL0435 - recurrence, treated in Emergency Room clinic at Kaiser on
AL0436 - 080409. ref SDS 31 EH5K
AL0438 - ..
AL0439 - [On 080417 NEUTS 0.95 lowest ever blood counts reflects
AL0440 - concern today about holding blood counts. ref SDS 32 PU6K
AL0442 - ..
AL0443 - [On 080417 Millie notifies medical team that concern today
AL0444 - about maintaining blood counts for weekly chemotherapy
AL0445 - treatments, ref SDS 33 P45J, correctly anticipated
AL0446 - problems that have occurred consistently. ref SDS 33 4W8X
AL0448 - ..
AL0449 - [On 080418 Brigid says Neupogen treatment not needed this
AL0450 - week, because not Carboplatin chemothearpy next week for
AL0451 - 4th treatment in the cycle; discusses new treatment plan
AL0452 - lowering dose of Carboplatin to achieve consistent
AL0453 - treatments. ref SDS 34 MR3L
AL0455 - ..
AL0456 - [On 080423 Millie notifies medical team to maintain full
AL0457 - dose of Carboplatin chemotherapy to optimize prospects of
AL0458 - recovery based on favorable response to initial
AL0459 - treatments. ref SDS 35 TY6Y
AL0461 - ..
AL0462 - [On 080821 case study neutropenia low blood counts causes
AL0463 - Millie to miss 4 chemotherapy treatments with Carboplatin
AL0464 - from beginning 2nd arm of clinical study. ref SDS 37 EP7N
Cellulitis Subsides from Recurrence on 080304 Examination at Kaiser
B50401 - ..
B50402 - Cellulitis Subsides
B50405 - 3. Seems like Cellulitis has subsided. ref DIT 2 I46J
B50407 - [On 080312 Millie confirmed that Cellulitis has fully
B50408 - subsided responding to treatment beginning on 080304.
B50409 - ref SDS 23 RU4Q
Medications Current Notified Coagulation Control Department Coordina
BK0401 - ..
BK0402 - Medications Coagulation Control Department Notified
BK0405 - 4. I sent a letter to Gloria listing all the medications so she
BK0406 - can figure out Coumadin [see above, ref SDS 0 RW3T]. I just
BK0407 - wonder if there is any downside to taking so many things. I
BK0408 - feel like opening my own pharmacy. ref DIT 2 U46M
Backup Teamwork Referral Coordination Plan UCSF Relies on Kaiser Ver
CG0401 - ..
CG0402 - Backup Medical Review Strengthens Health Care
CG0403 - Referral Coordination Plan UCSF Relies Kaiser Backup Review
CG0405 - Follow up ref SDS 21 JT3L, ref SDS 6 FT5H.
CG0407 - 5. Brigid said yesterday they are glad you see me regularly so
CG0408 - they have a backup because my case is really complex.
CG0409 - ref SDS 21 JT3L I'm very glad too. ref DIT 2 N57H
CG0411 - [On 080312 primary care physician at Kaiser concurrs Kaiser
CG0412 - and UCSF functioning as a team for Millie's treatment on
CG0413 - referral deserves support. ref SDS 23 HT3U
CG0415 - ..
CG0416 - [On 090213 1140 Doctor Johnson explains Millie's good
CG0417 - results surviving stage IV cancer 3 times longer than other
CG0418 - patients show benefits of synergy between Kaiser's
CG0419 - knowledge of patient history, and UCSF research have been
CG0420 - optimized through communication that integrates Kaiser's
CG0421 - team care model of case management with the UCSF practice
CG0422 - of comprehensive care. ref SDS 38 685I