THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: October 22, 2008 02:00 PM Wednesday;
Millie at Kaiser biopsy neck evaluate qualify sunitinib clinical study.
2...Administrative Background Scheduling FNA Biopsy Check Status Change
3...Patient History Reviewed Adenopathy Left Supraclavicular
4...CT Test Scans 080911 Not Sufficient to Evaluate Neck Nodes
5...FNA Biopsy Left Supraclavicular Two Specimens
6...Check Stats Change ER PR HER2 neu UCSF Order
7...Pathology Test Results Within Days or Maybe a Week
8...Commend Kaiser Surgery Department Expedite Referral Coordination
9...Surgery Advice Nurse Commended Excellent Coordination Expedite Work
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FNA Biopsy Adenopathy Cancer Left Supraclavicular Meeting Check Stat
1703 - ..
1704 - Summary/Objective
170501 - Follow up ref SDS 23 0000. ref SDS 21 0000.
170507 - ..
1708 - Progress
170901 - Administrative Background Scheduling FNA Biopsy Check Status Change
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
Adenopathy Swelled Lymph Node Neck Left Supraclavicular Patient Hist
3604 - Meeting Doctor Daamen
360501 - ..
360502 - Patient History Reviewed Adenopathy Left Supraclavicular
360504 - Follow up ref SDS 23 0D6F.
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.
CT Test Scans 080911 Not Enough of Neck to Evaluate Lymph Nodes Aden
550401 - ..
550402 - CT Test Scans 080911 Not Sufficient to Evaluate Neck Nodes
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
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.
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
FNA Biopsy Left Supraclavicular Neck Two Specimens Drawn Evaluate Ad
740401 - ..
740402 - FNA Biopsy Left Supraclavicular Two Specimens
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.
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.
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.
FNA Biopsy Left Supraclavicular Neck Two Specimens Drawn Evaluate Ad
930401 - ..
930402 - Check Stats Change ER PR HER2 neu UCSF Order
930404 - Millie reminded the doctor to request that the lab check for status
930405 - change with the pathology on the biopsy today.
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
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
930488 - ..
930489 - Pathology Test Results Within Days or Maybe a Week
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.
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
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.
Default Null Subject Account for Blank Record
9404 - 1430
940501 - ..
940502 - Commend Kaiser Surgery Department Expedite Referral Coordination
940503 - Surgery Advice Nurse Commended Excellent Coordination Expedite Work
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.
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