CONTACTS 

SUBJECTS
FNA Biopsy Adenopathy Cancer Left Supraclavicular Meeting Check Stat

1703 -
1703 -    ..
1704 - Summary/Objective
1705 -
170501 - Follow up ref SDS 23 0000. ref SDS 21 0000.
170502 -
170503 -
170504 -
170505 -
170507 -  ..
1706 -
1707 -
1708 - Progress
1709 -
170901 - Administrative Background Scheduling FNA Biopsy Check Status Change
170902 -
170903 - During examination at UCSF on 081016 Brigid palpated a swelled lymph
170904 - node in the left supraclavicular.  Later during the same meeting,
170905 - Doctor Rugo confirmed this finding, ref SDS 15 J34X, which was first
170906 - reported during examination at UCSF on 080821. ref SDS 11 4C6O  The
170907 - primary care physician at Kaiser noticed this swelled node the
170908 - following week on 080829, ref SDS 12 RP8T, and confirmed in a letter to
170909 - the medical team. ref SDS 12 RP8T
170911 -  ..
170912 - During the meeting at UCSF on 081016, Doctor Rugo ordered a biopsy of
170913 - the swelled node to check for cancer. ref SDS 15 J36R  Cancer in the
170914 - lymph node signals progression of disease, which will end Millie's
170915 - treatment with the clinical study for cetuximab and Carboplatin, begun
170916 - on 070201, and the 2nd arm with Carboplatin started on 080313.
170917 - ref SDS 9 TZ8I  Doctor Rugo also noticed on 081016 increased intensity
170918 - of IBC rash on the left arm. ref SDS 15 J34U
170920 -  ..
170921 - The doctor proposed changing treatment to a new clinical study for
170922 - sunitinib. ref SDS 15 J38U  The primary care physician at Kaiser was
170923 - notified that sunitinib is another "targeted" treatment, like
170924 - cetuximab that has been effective the past 2 years. ref SDS 15 J35X
170925 - Millie notified the primary care physician about Doctor Rugo's work
170926 - plan to get a biopsy of the swelled lymph node in order to evaluate
170927 - progression of disease, which would qualify Millie to start treatment
170928 - with sunitinib clinical trial when she returns from vacation on
170929 - 081106. ref SDS 15 J36R
170931 -  ..
170932 - The next day, Millie called Arlette on 081017 to ask about progress
170933 - ordering the biopsy.  Arlette planned to remind the doctor to order
170934 - the biopsy. ref SDS 17 UP5G  Millie was at Kaiser later in the
170935 - afternoon for Neupogen treatment, needed to continue treatments in the
170936 - clinical trial for cetuximab and Carboplatin until, Millie can start
170937 - treatment in the sunitinib clinical study.  At that time, Arlette
170938 - reported that she had talked to the doctor, and he planned to order
170939 - the biopsy required for Millie to start treatment with sunitinib.
170940 - ref SDS 17 UP6I
170942 -  ..
170943 - The next day, on 081018 sunitinib was described at a seminar on new
170944 - cancer treatments as more advanced, and so more effective than
170945 - cetuximab. ref SDS 18 IT8V  Since cetuximab has been very effective,
170946 - the prospect that getting treatment with sunitinib would be even
170947 - better elevated interest in getting the biopsy at Kaiser in order to
170948 - start treatment with sunitinib.
170950 -  ..
170951 - The next day on 081019, Millie notified the primary care physician of
170952 - good news at the seminar, reporting favorably on sunitinib, so the
170953 - doctor can be prepared to discuss switching treatments at UCSF, when
170954 - Millie meets with the doctor on Friday. ref SDS 19 DZ6X
170956 -  ..
170957 - Yesterday on 081021, Millie received a letter from the primary care
170958 - physician at Kaiser, ref SDS 20 YR6O, advising that a meeting was
170959 - scheduled on Thursday at 1050 in the Surgery Department.  This
170960 - conflicted with Millie getting treatment at UCSF on Thursdays until
170961 - about 1200.  The letter from Kaiser disclosed that getting the biopsy
170962 - would require a second meeting. ref SDS 20 0X9T  Scheduling two (2)
170963 - meetings to get an FNA biopsy conflicts with Millie's patient history;
170964 - on 040303 Millie was referred to the Head and Neck Department,
170965 - ref SDS 2 VF77, for an FNA procedure performed the same day with only
170966 - a single visit. ref SDS 2 Y171  Multiple visits to get an FNA biopsy
170967 - would delay Millie's treatment days, weeks, even months, as occurred
170968 - in 2004, when Millie was suddenly taken off Avastin treatment due to
170969 - discovering PE on 041104, ref SDS 6 N438, and did not resume
170970 - treatment for advancing cancer until 050104. ref SDS 7 407N
170972 -  ..
170973 - Therefore, Kaiser was called to coordinate adjustments to expedite
170974 - referral work, similar to coordinating on 080711 with the Infusion
170975 - Clinic, ref SDS 10 TE9G; and with the CT Department on scheduling a CT
170976 - test. ref SDS 10 7K8I and ref SDS 10 PP7O
170978 -  ..
170979 - The Advise Nurse, Anne, in the Surgery Department reported that the
170980 - referral from Oncology for a biopsy in the Surgery Department did not
170981 - specify FNA nor checking for status change of ER PR HER2. ref SDS 20
170982 - IW44  Anne talked to Doctor Riley-Paull, who was in the office and
170983 - familiar with Millie's patient history. ref SDS 20 WN55  The doctor
170984 - changed the referral to Head and Neck. ref SDS 20 03GE  Anne hand
170985 - carried the change down the hall and submitted the referral to Jane,
170986 - the Advise Nurse in the Head and Neck Department. ref SDS 20 WO4X  Anne
170987 - recommended contacting the Head and Neck Department to expedite
170988 - scheduling the FNA biopsy work. ref SDS 20 E550
170990 -  ..
170991 - Millie sent a letter notifying the primary care physician of changes
170992 - in the Oncology referral, ref SDS 21 XK79, and requested support
170993 - scheduling the work today, or as soon as possible. ref SDS 21 3U5W
170995 -  ..
170996 - This morning, Millie visited the Head and Neck Department at 0830 to
170997 - expedite the work and clarify scope.  She delivered the UCSF order for
170998 - FNA biopsy, and requesting check for status change. ref SDS 23 N1D5
170999 - Jane the Advise Nurse advised that Kaiser was able to schedule Millie
171000 - for the biopsy this afternoon at 1400. ref SDS 23 0D6F
171002 -  ..
171003 - Millie sent a letter to the primary care physician explaining the good
171004 - news, and thanking the doctor for timely coordination. ref SDS 24 2Y9Q
171005 -
171006 -
171007 -
1711 -

SUBJECTS
Adenopathy Swelled Lymph Node Neck Left Supraclavicular Patient Hist

3603 -
3604 - Meeting Doctor Daamen
360501 -  ..
360502 - Patient History Reviewed Adenopathy Left Supraclavicular
360503 -
360504 - Follow up ref SDS 23 0D6F.
360505 -
360506 - Doctor Daamen palpated the lump in the left supraclavicular, and asked
360507 - about patient history of this node.
360509 -  ..
360510 - Generally, on 040303 Doctor Daamen's colleague, Doctor Laio, in Head
360511 - and Neck Department performed FNA procedure specified for today.
360512 - ref SDS 2 Y171  On 040309 the doctor reported the biopsy was positive
360513 - for cancer. ref SDS 3 0001  This finding supported diagnosis and
360514 - treatment for metastatic breast cancer on 040318. ref SDS 4 8R6M  A
360515 - few months later on 040614, diagnosis was revised, based on a
360516 - subsequent punch biopsy performed by Doctor Riley-Paull during minor
360517 - surgery on 040419 for a port catheter, to secondary IBC, ref SDS 5
360518 - 6T5G, which requires treatment for Stage IV cancer. ref SDS 5 6M9H
360520 -  ..
360521 - Millie has been treated continuously since that time, with a break in
360522 - 2006 following mastectomy surgery on 051021 that reduced symptoms of
360523 - IBC for about 7 months.  She began treatment on referral at UCSF on
360524 - 070201.
360526 -  ..
360527 - Last week on 081016, Doctor Rugo at UCSF noticed a swelled node again
360528 - in the left supraclavicular, ref SDS 15 J34X, in the area where Doctor
360529 - Laio reported cancer in 2004.  A few months earlier on 080821 UCSF
360530 - reported finding a swelled node in the left supraclavicular.
360531 - ref SDS 11 4C6O  The following week on 080829 the primary care
360532 - physician in Oncology at Kaiser in Walnut Creek palpated the same
360533 - swelled node, ref SDS 12 RP8T, confirming UCSF findings on 080821.
360534 - Last month on 080918 the node had not increased in size.  The agenda
360535 - for the meeting specified checking this location.  Examination at UCSF
360536 - did not find the node. ref SDS 14 4C6O  This aligned with the report
360537 - on the CT test on 080911, which made no findings of adenopathy in the
360538 - left supraclavicular, shown by review on 080912. ref SDS 13 5O6N
360540 -  ..
360541 - Millie reported today that self-palpation since the initial report on
360542 - 080821 at UCSF, indicates the node has not increased.
360544 -  ..
360545 - Patient history of evident stable size, rather than growing, suggests
360546 - possibility the node is not cancer.
360548 -  ..
360549 - Today, Doctor Daamen described the node as "floating," which is
360550 - similar to Doctor Rugo's comment that the node is "slippery," and so
360551 - difficult to detect.
360552 -
360553 -
360554 -
360555 -
3606 -

SUBJECTS
CT Test Scans 080911 Not Enough of Neck to Evaluate Lymph Nodes Aden

5503 -
550401 -  ..
550402 - CT Test Scans 080911 Not Sufficient to Evaluate Neck Nodes
550403 -
550404 - Doctor Daamen checked the CT test scans on Kaiser's computer.
550406 -  ..
550407 - She noted there is nothing shown in the test on 080425, nor in the
550408 - next test on 080718.  The doctor commented that these tests performed
550409 - in the CT Department at Kaiser in Walnut Creek show slides for enough
550410 - of the neck to evaluate adenopathy in the left supraclavicular.
550412 -  ..
550413 - Doctor Daamen indicated that the CT test at Kaiser in Oakland on
550414 - 080911 may not have covered enough of the neck to make findings of
550415 - swelled nodes in the left supraclavicular.  This may account for
550416 - discontinuity of examinations on 080821 and 080829 finding swelled
550417 - lymph node, and subsequent CT test on 080911 that makes no findings,
550418 - reported the next day on 080912. ref SDS 13 5O6N
550419 -
550420 -        [On 081112 report on CT test at Kaiser in Walnut Creek on
550421 -        081107, was compared with the earlier test on 080718,
550422 -        ref SDS 38 WU3F, rather than the test on 08911 as Doctor Daamen
550423 -        did today.
550425 -  ..
550426 - Millie's letter to the medical team on 080827 reported requirement for
550427 - the CT scan on 080911 to cover the neck in order to monitor new
550428 - findings from examinations at UCSF and Kaiser.  Doctor Daamen's report
550429 - today indicates that something went wrong.
550431 -  ..
550432 - The order for the CT test required on 081107 can try again to specify
550433 - covering the neck to cross check findings.
550434 -
550435 -        [On 081123 agenda for meeting with primary care physician at
550436 -        Kaiser proposes specifying CT test to cover the neck to
550437 -        evaluate adenopathy common to IBC patients. ref SDS 25 L44P
550439 -         ..
550440 -        [On 081024 during meeting with primary care physicina in
550441 -        Oncology the doctor ordered CT scan to include the neck for
550442 -        evaluating adenopathy in the left supraclavicular. ref SDS 30
550443 -        U55F
550444 -
550445 -
550446 -
550447 -
550448 -
5505 -

SUBJECTS
FNA Biopsy Left Supraclavicular Neck Two Specimens Drawn Evaluate Ad

7403 -
740401 -  ..
740402 - FNA Biopsy Left Supraclavicular Two Specimens
740403 -
740404 - Doctor Daamen explained the procedure today will require two needle
740405 - punctures.  The area will initially be anesthetized.  This will be
740406 - somewhat painful.  The needle biopsies will still be painful, because
740407 - the anesthetic cannot reach the swelled node, which must be penetrated
740408 - to draw test tissue.
740410 -  ..
740411 - The doctor indicated that FNA is the least invasive biopsy procedure,
740412 - and this minimizes trauma to the neck which is a sensitive area.  The
740413 - UCSF order for the work plan on 081016 specified FNA biopsy for the
740414 - swelled lymph node in the left supraclavicular, noted in Millie's
740415 - letter to the medical team. ref SDS 15 J36R
740417 -  ..
740418 - Millie was grateful that the procedure today did not require running a
740419 - tube through her nose, that was a very unpleasant experience for the
740420 - FNA biopsy on 040303. ref SDS 2 Y143
740422 -  ..
740423 - When Doctor Daamen punctured the skin and advaced the the FNA needle
740424 - toward and then penetrated the lumps in the left supraclavicular,
740425 - Millie reported a sudden jolt or shock of electricity running down her
740426 - left arm.  Doctor Daamen praised Millie for resisting the natural
740427 - tendency to react against the jolt by moving her head and neck or
740428 - lifting her arm for relief.
740430 -  ..
740431 - Doctor Daamen said the needle must have pressed against or near a
740432 - nerve in the area of the lump.  She feels there was no permenant
740433 - damage, because Millie showed not continuing symptoms.
740435 -  ..
740436 - The doctor described risks of permenant damage to nerve tissue,
740437 - especially in the neck area, and noted this risk is reduced by using a
740438 - the FNA biopsy procedure that exposes minimal tissue to damage with a
740439 - very small diameter needle.  Evidently, the core biopsy uses a much
740440 - large needle, which increases risks of nerve damage.
740441 -
740442 -              [On 081106 Doctor Daament plans to collaborate with
740443 -              Doctor Kahn to perform the core biopsy at an angle in
740444 -              order to reduce risks of permenant damage to nerve tissue
740445 -              while testing for status change. ref SDS 36 XL6F
740447 -  ..
740448 - The two specimens drawn today required three needle punctures.
740449 -
740450 -              [On 081023 FNA biopsy positive for breast cancer,
740451 -              ref SDS 26 4Q9Q; need to do core biopsy because lab says
740452 -              FNA biopsy does not produce enough material to check for
740453 -              status change. ref SDS 26 4Q5V
740455 -               ..
740456 -              [On 081023 Kaiser does not hear from UCSF, schedules
740457 -              Millie for core biopsy to test for status change; work to
740458 -              be performed in Kaiser Head and Neck Department on 081024
740459 -              1130. ref SDS 26 667F
740461 -               ..
740462 -              [On 081023 UCSF medical team sent 5 letters saying FNA
740463 -              biopsy adequate for testing status change, ref SDS 27
740464 -              NI7S; Doctor Rugo's letter said pathology on the biopsy
740465 -              performed on 081022 showing positive for cancer stops
740466 -              treatment with cetuximab and Carboplatin. ref SDS 27
740467 -              D65G; the last letter says hopefully Kaiser will use FNA
740468 -              procedure to test for status change. ref SDS 27 KY8R
740470 -               ..
740471 -              [On 081024 Kaiser Head and Neck Department responds to
740472 -              UCSF Oncology saying the Kaiser Lab requires core
740473 -              biopsy to test for status change. ref SDS 28 008H
740475 -               ..
740476 -              [On 081024 Millie met with Kaiser Head and Neck
740477 -              Department; decided to perform core biopsy to test for
740478 -              status change, because Kaiser Lab uses different
740479 -              procedures from the lab UCSF uses to check biopsy
740480 -              tissue for status change; Kaiser further decided to
740481 -              defer performing core biopsy work until 081107 after
740482 -              Millie returns from vacation to reduce risks of
740483 -              complications cascading out of control without ready
740484 -              access to Kaiser health care while traveling.
740485 -              ref SDS 29 G15K
740487 -               ..
740488 -              [On 081027 Kaiser defers core biopsy again from 081107
740489 -              until 081117 1130 due to emergency surgery that later
740490 -              was added to Doctor Wong's calender for 081107.
740491 -              ref SDS 31 G15K
740493 -               ..
740494 -              [On 081027 Millie notified UCSF that Kaiser delayed
740495 -              core biopsy again to 081117, ref SDS 32 G15K, and asks
740496 -              if this will delay getting treatment for cancer with
740497 -              the UCSF work plan for starting the sunitinib clinical
740498 -              study. ref SDS 32 R79W
740500 -               ..
740501 -              [On 081027 Glenna called and planned to ask Doctor Rugo
740502 -              about requirements for biopsy to test status change in
740503 -              order for Millie to start the sunitinib clinical study.
740504 -              ref SDS 33 934O
740506 -               ..
740507 -              [On 081029 letter to UCSF discusses doing FNA biopsy for
740508 -              status check at UCSF instead of core biopsy at Kaiser.
740509 -              ref SDS 34 C49U
740511 -               ..
740512 -              [On 081031 letter to UCSF with copy to Kaiser asks about
740513 -              doing FNA biopsy at UCSF. ref SDS 35 NN5S
740515 -               ..
740516 -              [On 081031 Glenna called and advised that biopsy for
740517 -              status change is not a requirement for the sunitinib
740518 -              clinical trial, and so recommended contacting Doctor Rugo
740519 -              UCSF and Doctor Johnson at Kaiser. ref SDS 35 T27H
740521 -  ..
740522 - The doctor noted that the second penetration did not draw enough fluid
740523 - for an adequate test, so a third attempt was needed to get the two
740524 - test specimens.
740526 -  ..
740527 - There was no evidence of excessive bleeding with Millie on Coumadin.
740528 - Doctor Daamen seemed aware from checking the medical chart of Millie's
740529 - Coumadin treatments for pulmonary embolism.
740531 -  ..
740532 - The needle puncture was covered with a small round bandaid.  The
740533 - doctor advised that slight coloration will dissipate in a few hours.
740534 -
740535 -
740536 -
7406 -

SUBJECTS
FNA Biopsy Left Supraclavicular Neck Two Specimens Drawn Evaluate Ad

9303 -
930401 -  ..
930402 - Check Stats Change ER PR HER2 neu UCSF Order
930403 -
930404 - Millie reminded the doctor to request that the lab check for status
930405 - change with the pathology on the biopsy today.
930406 -
930407 - Doctor Daamen asked for clarification of "status change."
930409 -  ..
930410 - She did not get a copy of the letter on 081016 to Kaiser submitting
930411 - UCSF order for the biopsy that specifies check for status change ER PR
930412 - HER2 neu. ref SDS 15 J36R
930414 -  ..
930415 - Millie is triple negative for ER, PR, HER2, shown in the report for
930416 - the biopsy at Kaiser on 020304 that diagnosed cancer, reviewed with
930417 - the doctor on 020321. ref SDS 1 LA7O   Triple negative status
930418 - qualified Millie to participate in the cetuximab Carboplatin clinical
930419 - study, reported on 070116, ref SDS 8 0Q7I, and this has been a very
930420 - successful "targeted" treatment, lasting nearly 2 years.  Now, 7 years
930421 - later, the doctor is checking for change of status from triple
930422 - negative to possibly HER2 positive, because this will significantly
930423 - expand treatments for Millie going forward.  Triple negative is a rare
930424 - condition, so most treatments aim for the larger population.
930426 -  ..
930427 - On 081016 UCSF proposed Millie for treatment with the sunitinib
930428 - metronomic protocol, ref SDS 15 J38U, which provides "multi-targeted"
930429 - relief of cancer symptoms, and reduces recurrence, reported on 081018.
930430 - ref SDS 18 IT8V  Accordingly, if Millie has experienced status change,
930431 - then the sunitinib treatment could be an even stronger solution,
930432 - noting as well Doctor Rugo's letter on 081017 saying sunitinib is not
930433 - just for triple negative patients. ref SDS 16 6J3T
930435 -         ..
930436 -        [On 081107 Doctor Kahn asks Millie for assurance that core
930437 -        biopsy to test for status change is needed. ref SDS 37 WZ70
930439 -         ..
930440 -        [On 081119 Kaiser submitted a summary of final pathology
930441 -        report, ref SDS 39 5O8G, for the biopsy on 081107, ref SDS 37
930442 -        496L, and it appears status is unchanged, still triple
930443 -        negative. ref SDS 39 UQ5P
930445 -  ..
930446 - The doctor said that the referral received from Surgery did not
930447 - specify anything about status change.  This aligns with Anne's report
930448 - yesterday that she did not include testing for "status change" in the
930449 - referral sent from Surgery, because status change is not mentioned in
930450 - the referral from Oncology. ref SDS 20 P73H
930452 -  ..
930453 - Millie explained having submitted this morning to Jane, the Advice
930454 - Nurse, for the Head and Neck Department, an order issued by UCSF on
930455 - 081016 for the FNA left supcalvicular and check for status change ER,
930456 - PR, HER2 neu. ref SDS 23 IE34
930458 -  ..
930459 - Doctor Daamen recalled seeing a form from UCSF, but did not look
930460 - through it closely, because she relied on the Kaiser internal referral
930461 - to have correctly performed prior "paperwork." The doctor left the
930462 - examination room, and returned in 5 minutes with the UCSF order for
930463 - the work today to test for status change.
930465 -  ..
930466 - The doctor wrote on the Kaiser transmittal for sending the biopsy
930467 - specimens to the pathology lab that the lab should test the specimens
930468 - for status change on ER PR HER2 neu.  The doctor also made a copy of
930469 - the UCSF order and attached it to the biopsy specimens.
930471 -  ..
930472 - This level of effort provides a reasonable chance that the lab will
930473 - perform the work plan ordered by the Doctor Rugo at UCSF on 081016.
930474 - ref SDS 15 J36R
930475 -
930476 -              [On 081023 FNA biopsy positive for breast cancer; need
930477 -              to do core biopsy because lab says FNA biopsy does not
930478 -              produce enough material to check for status change.
930479 -              ref SDS 26 W15N
930481 -               ..
930482 -              [On 081107 core biopsy performed to test for status
930483 -              change. ref SDS 37 496L
930484 -
930485 -
930486 -
930488 -  ..
930489 - Pathology Test Results Within Days or Maybe a Week
930490 -
930491 - The doctor advised that test specimens drawn today will be taken to a
930492 - pathology lab here at the Kaiser Walnut Creek hospital.  They might
930493 - get results in time for review during the meeting with the primary
930494 - care physician at Kaiser on Friday, 081024.  If the local lab is busy,
930495 - then the work could be sent to a lab in San Francisco.  In that case,
930496 - results might be availble in a week, similar to experience for the
930497 - previous FNA biopsy on 040303, when results were reported a week later
930498 - on 040309. ref SDS 3 0001
930500 -  ..
930501 - Doctor Daamen indicated Kaiser practice to perform a more vigorous
930502 - core biopsy procedure, if results of the test today are negative.
930503 - This dual biopsy procedure meets quality control standards to verify
930504 - results.
930505 -
930506 -              [On 081023 FNA biopsy positive for breast cancer; need
930507 -              to do core biopsy because lab says FNA biopsy does not
930508 -              produce enough material to check for status change.
930509 -              ref SDS 26 4Q9Q
930511 -               ..
930512 -              [On 081023 Doctor Daamen schedules follow up core biopsy
930513 -              on 081024 with Doctor Wong at 1130. ref SDS 26 667F
930514 -
930516 -               ..
930517 -              [On 081024 Millie met with Kaiser Head and Neck
930518 -              Department; decided to perform core biopsy to test for
930519 -              status change, because Kaiser Lab uses different
930520 -              procedures from the lab UCSF uses to check biopsy tissue
930521 -              for status change; Kaiser further decided to defer
930522 -              performing core biopsy work until 081107 after Millie
930523 -              returns from vacation to reduce risks of complications
930524 -              cascading out of control without ready access to Kaiser
930525 -              health care while traveling. ref SDS 29 G15K
930527 -  ..
930528 - Results of the test either way have potentially positive consequences.
930529 - If the new node in the neck is not cancer, then Millie may be able to
930530 - get a few more cycles on the current treatment.  If the test is
930531 - positive, then Millie may qualify for a new clinical study with
930532 - sunitnib, which is another "targeted" chemotherapy, reported on
930533 - 081016. ref SDS 15 J35X  Reporting at a seminar on 0810118 had very
930534 - positive prospects to improve cetuximab, ref SDS 18 IT8V, so this
930535 - creates conflicted feelings about hoping for results on the biopsy
930536 - today.
930538 -               ..
930539 -              [On 081023 FNA biopsy positive for breast cancer; need
930540 -              to do core biopsy because lab says FNA biopsy does not
930541 -              produce enough material to check for status change.
930542 -              ref SDS 26 W15N
930544 -  ..
930545 - Millie thanked Doctor Daamen for being available today to do the
930546 - biopsy on short notice, and for careful, thorough work, including
930547 - helpful explanations of what was going to happen during the procedure.
930549 -  ..
930550 - Doctor Daamen provided an email address for distribution of
930551 - communication to the medical team.
930553 -  ..
930554 - The actual procedure took about 10 minutes.  With review of patient
930555 - history and review of CT scans, the meeting lasted about 30 minutes.
930556 -
930557 -
930558 -
9306 -

SUBJECTS
Default Null Subject Account for Blank Record

9403 -
9404 - 1430
940501 -  ..
940502 - Commend Kaiser Surgery Department Expedite Referral Coordination
940503 - Surgery Advice Nurse Commended Excellent Coordination Expedite Work
940504 -
940505 - After meeting with Doctor Daamen, Millie stopped at the Surgery
940506 - Department down the hall from the Head and Neck Department on the 3rd
940507 - floor.
940508 -
940509 - Asked to talk with Anne the Advice Nurse.
940511 -  ..
940512 - Waited for about 10 minutes.  Anne came to the patient reception
940513 - counter.
940515 -  ..
940516 - Millie reported that she just completed the FNA biopsy.  Took about 10
940517 - minutes, ref SDS 0 NZ5N, as a result of Anne coordinating the referral
940518 - yesterday.  Millie thanked Anne for extra effort checking the record
940519 - to assess requirements, ref SDS 20 PQ5R, and for taking immediate
940520 - action to align the referral with requirements based on patient
940521 - history. ref SDS 20 WO4X
940523 -  ..
940524 - Anne will tell Doctor Riley-Paull hello for Millie, and say thanks for
940525 - helping clarify the referral on Millie's biopsy yesterday. ref SDS 20
940526 - WO45
940527 -
940528 -
940529 -
940530 -
940531 -
940532 -
940533 -
940534 -
940535 -
940536 -
9406 -