THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: July 18, 2014 10:17 AM Friday; Rod Welch

Kathy called on ordering tires and meeting doctor on diagnosis of osteoporosis.

1...Summary/Objective
2...Chair Recliner Rocker Recliner Received
3...Meeting VA Sacramento Request Clarification Medication and triamcinolone


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CONTACTS 

SUBJECTS
Chair Recliner Rocker Swivel Receive Vendor Bid New Tires 40000 Mile                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0903 -    ..
0904 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090501 - Follow up ref SDS 4 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090507 -  ..
0906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0908 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0909 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090901 - Chair Recliner Rocker Recliner Received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090902 - 
090903 - Kathy has received her new chair for the living room.  She likes it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090904 - alot, because the foot rest works, correcting the problem with the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090905 - old chair.  The swivel feature is also helpful.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
150509 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
150510 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
150511 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160401 -  ..
160402 - Meeting VA Sacramento Request Clarification Medication and triamcinolone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160403 - 
160404 - Follow up ref SDS 3 5N3O.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160406 - Kath will visit Jamie Ward at the front desk of EDG Department for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160407 - VA in Sacramento, where we visited with Doctor Lee on 140509 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160408 - ref SDS 2 I167                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160410 -  ..
160411 - She will provide last four of ss for ID, and explain the customer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160412 - tried to refill Doctor Lee's prescription for Omeprazole, because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160413 - there were only 4 days supply taking 2 pills per day, prescribed by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160414 - Doctor Lee on 140509 0900. ref SDS 2 JG4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160416 -  ..
160417 - The VA online computer pharmacy system shows Doctor Lee's prescription                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160418 - for Omeprazole is scheduled to be filled on 140725, and provides no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160419 - means for the customer to correct this refill date, reported on 140715                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160420 - 1614. ref SDS 3 4Y6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
160422 -  ..
160423 - The cusotmer can adjust dose down to just one pill a day.  This will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160424 - extend supply to 140723.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
160426 -  ..
160427 - Since the VA has not submitted the Progress Notes we cannot verify the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
160428 - prescription should be 2 pills per day.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
160430 -  ..
160431 - If Doctor Lee approves switching to 1 pill per day, it would be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160432 - helpful to get the prescription refilled OA 140718, in order to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160433 - maintain continuity of medication.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
160435 -  ..
160436 - If the customer should be taking 2 pills per day, then timely refill                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160437 - is essential, and only the doctor can do this.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160439 -  ..
160440 - Additionally, Doctor Lee seemed to report after the EGD procedure on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160441 - 140509, that he omitted the triamcinolone injection. ref SDS 2 I167                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
160442 - This has caused increased swallowing difficulties shown by rising                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
160443 - vomitting beginning OA 140712, in case study on 120101 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
160444 - ref SDS 1 4E4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
160445 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160447 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160449 -  ..
1605 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1606 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1607 - 1135                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
1608 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
160801 - Kathy called.  She was able to speak with a nurse and explain issues.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
160802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160803 - The nurse said Doctor Lee is in the office today.  She will ask him                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
160804 - to call the customer before close of business.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
160805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160806 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
160808 -  ..
1609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1610 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
1611 - 1506                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
1612 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
161201 - Nurse Lapria.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
161202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161203 - She related talking to Kathy earlier today, and understanding the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
161204 - patient has been taking 1 pill a day, and wants to know if it should                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
161205 - be increased to 2 pills a day?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
161207 -  ..
161208 - Lapria was aware there is pending refill scheduled on 140725.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
161210 -  ..
161211 - Clarified that understood from the meeting on 140509, that the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161212 - ordered 2 pills a day.  Since refill is scheduled on 140725, there are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
161213 - only enough pills to take 2 a day until 140723.  If the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
161214 - actually ordered 2 pills per day, and feels that prescription should                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
161215 - be followed, then the refill should be updated to be issued today, in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161216 - order to arrive before pills run out.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161218 -  ..
161219 - Also explained poor results following procedure on 140509, that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161220 - omitted injecting the steriod.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
161222 -  ..
161223 - There has been increased difficulty swallowing shown by vomitting,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
161224 - beginning about 140712, as shown in case study on 120101 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
161225 - ref SDS 1 4E4M  This occurred previously when triamcinolone steriod                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
161226 - injections were not performed, shown in case study on 140509 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
161227 - ref SDS 2 I167  If the doctor did not omit the steriod, then this is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
161228 - occurring despite the injection, and if it was omitted, then it might                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161229 - be remedied by reducing the time for the next procedure from 6 months                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161230 - back to 4, i.e., next month in August.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
161232 -  ..
161233 - Lapria will ask the doctor to call back today, if he is in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
161234 - office.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
161235 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161236 -            [On 140801 in case study on 120101, Omeprazole not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
161237 -            delivered, ref SDS 1 F53K; aligns with prior delays getting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
161238 -            Omeprazole refill issued by VA on 140725, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
161239 -            140715 1614, ref SDS 3 4O6H, and prescribed on 140509, to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
161240 -            take 2 pills a day for achalasia - relieve acid burn that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
161241 -            inflames LESV, ref SDS 2 JG4K, confirmed Progress Notes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
161242 -            ref SDS 2 P43G  Call to VA on 140718 to expedite delivery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
161243 -            asked if necessary to continue taking pills when supply                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
161244 -            runs out. ref SDS 0 U76M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
161246 -             ..
161247 -            [On 140802 1821 received Omeprazole refill from VA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
161248 -            ref SDS 5 5N3O   Resume taking 2 pills per day, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
161249 -            case study on 120101. ref SDS 1 5F6M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161251 -             ..
161252 -            [On 140810 1839 letter to Doctor Lee requesting EGD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
161253 -            dilation with triamcinolone injection soonest, if                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
161254 -            cancellation occurs; but, not an emergency, ref SDS 6 W83K,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
161255 -            based on history rising vomitting swallowing problems,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
161256 -            shown in patient history case study on 120101, beginning                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
161257 -            140712. ref SDS 1 4E4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
161259 -             ..
161260 -            [On 140814 2227 agenda meeting with Primary Care requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
161261 -            referral to advance EGD dilation for resolving increased                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
161262 -            swallowing problems. ref SDS 7 K059                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
161264 -             ..
161265 -            [On 140819 0800 during meeting at VA Primary Care Clinic in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
161266 -            Martinez, Doctor Sandhu indicated Doctor Lee at VA Medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
161267 -            Center in Sacramento will be notified about rising                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
161268 -            achalasia symptoms for consideration to advance EGD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
161269 -            dilation procedure. ref SDS 8 EX78                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
161270 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161271 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161272 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161273 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161274 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161275 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161276 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161277 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
161278 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1613 -