CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 30 0000. ref SDS 28 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 090908 meeting with Doctor Lee at VA Clinic Martinez reported chest
040902 - pains hiking up first hill at Lafayette Reservoir, and which persisted
040903 - for entire lap. ref SDS 1 MY4N Previously, pain only occurred for
040904 - short distance after 1st hill, then subsided for rest of lap, and any
040905 - additional laps. Chest pain recurred 3 days in a row. Requested
040906 - Doctor Lee order EGD dilation procedure to resolve achalasia
040907 - swallowing problem, expecting this to end chest pain caused by
040908 - esophagus pressing on lungs. ref SDS 1 BU63 Doctor Lee also ordered
040909 - EKG and stress tests to assess possible coronary artery disease (CAD).
040910 - ref SDS 1 BU6W
040912 - ..
040913 - On 091002 0900 Doctor Egan, Oncology Department reports stress test
040914 - shows failure on 10 of 11 probes tested, ref SDS 2 1W5I; diagnosis
040915 - triple vessel disease - orders angiogram test to evaluate heart
040916 - problems. ref SDS 2 V86G
040918 - ..
040919 - On 091021 0716 angiogram test (cardiac catheterization) discovers
040920 - blockages in multiple cornorary arteries, ref SDS 3 7L43, schedule
040921 - heart bypass surgery on 091222. ref SDS 3 WB3K
040923 - ..
040924 - On 091021 0716 at 1429 case study VA 10+ doctors ask for patient
040925 - history achalasai and discovery of cornorary artery disease (CAD),
040926 - beginning with chest pains reported today. ref SDS 3 LJ7L
040928 - ..
040929 - On 091022 0600 CABG Progress Notes report INDICATIONS FOR SURGERY:
040930 - Patient 64-year-old man recent onset of angina. Cardiac
040931 - catheterization found extremely tight LAD lesion with TIMI II flow.
040932 - He also had multiple other lesions and severe three-vessel disease.
040933 - Referred for urgent coronary artery bypass grafting. He has normal
040934 - ventricular function. ref SDS 10 C59K Locations of 4 byass grafts was
040935 - reported. ref SDS 10 HT9G
040937 - ..
040938 - On 091022 0600 CABG Progress Notes report finding "good quality" veins
040939 - that are "good targets" for heart bypass grafts - gives confidence
040940 - there is not general widespread circulatory disease, and that
040941 - replacement grafts can hold up for a long time with good post-op diet
040942 - and exercise. ref SDS 10 YI7K
040944 - ..
040945 - On 091029 0700 patient hiking 10 laps around Telemetry ward, 3 - 6
040946 - times per day, and at all hours, e.g., 2300, 0200, 0500, 1100, 1500,
040947 - and fitted between meals, meetings, calls, tests, and rest throughout
040948 - the day. Generally averaging 3 - 4 miles per day, ref SDS 5 01F9,
040949 - Hiking is prescribed therapy to strengthen the heart and circulatory
040950 - system to recover from cardiothoracic surgery on 091022. It helps
040951 - dissipate pain and illness feeling from surgery that occur throughout
040952 - the day, reducing reliance on medications. ref SDS 5 PS7H
040954 - ..
040955 - On 091030 1742 Ultrasound results reviewed show evidence of thrombus
040956 - of right IJ vein. ref SDS 10 JL73
040958 - ..
040959 - On 091104 0718 discharged from VA recovering from quadruple heart
040960 - bypass surgery, ref SDS 6 PR4V, performed on 091022 0700. ref SDS 4
040961 - PQWU; received medical record with list of medications, also on 091104
040962 - 0718, ref SDS 6 1Q6P, and follow up meetings. ref SDS 6 9T6O
040964 - ..
040965 - On 100104 0930 meeting Primary Care VA Martinez Clinic Doctor Sandhu
040966 - indicated patient demonstrates good recovery from heart surgery on
040967 - 091022, and Heller Myotomy surgery to recover from achalasia,
040968 - performed at VA in San Francisco on 091216. ref SDS 8 PP8W
040970 - ..
040971 - On 100104 0930 medications - continue Simvastatin 20 mg 1 pill per
040972 - day, post CABG prescription ordered by Doctor Sandhu, primary care
040973 - physician. ref SDS 8 3X4L
040975 - ..
040976 - On 100721 0800 visit Doctor Sandhu Martinez VA; patient demonstrates
040977 - continuing recovery from heart surgery last October, ref SDS 9 PP8W;
040978 - patient paused Simvastatin after completing initial prescription on
040979 - 091220. ref SDS 9 3X4L Lab on 100610 shows cholesterol HDL 35, and
040980 - LDL 209 increased from 164. ref SDS 9 HY76 Doctor increased dose of
040981 - Simvestatin 40 mg. ref SDS 9 RP4F New lab ordered today shows
040982 - cholesterol reversed long-term decline and increased dramatically in
040983 - just 30 days, suggesting possibly error in lab testing process.
040984 - ref SDS 9 E19L
040986 - ..
040987 - On 101207 0906 lab shows cholesterol LDL 96 fell 40% from 209, and HDL
040988 - 47 increased 30% from 35, after Doctor Sandhu doubled Simvastatin 40
040989 - mg per day; resulting in reduced risk of coronary artery disease (CAD)
040990 - and heart attack. ref SDS 11 E19L
040992 - ..
040993 - On 110406 1230 follow up treadmill stress test performed; initial
040994 - indications are 100% performance, with one node showing possible
040995 - slight irregularity. ref SDS 12 OF8F
040997 - ..
040998 - On 110415 0900 patient reports to Doctor Egan in Cardiology VA Clinic
040999 - Martinez hiking increased, now includes doing 11 miles twice per week.
041000 - ref SDS 13 527F
041002 - ..
041003 - On 130603 0930 Doctor Egan in Cardiology at VA Clinic Martinez
041004 - presents research in Emedicine Health showing Atorvastatin side
041005 - effects include increased thirst, increased urination, hunger, dry
041006 - mouth, fruity breath odor, drowsiness, dry skin, blurred vision.
041007 - ref SDS 14 BV4I
041009 - ..
041010 - On 131125 0005 research indicates Atorvastatin 10 Ezetimibe 10
041011 - Increase HDL 5% TG 30% Lower LDL-C 50%. ref SDS 15 PU6I
041013 - ..
041014 - On 131125 0005 research in Drugs.Com indicates Ezetimibe less common
041015 - side effects include Dizziness, Dryness or soreness of throat,
041016 - Hoarseness, which have all occurred and may compound side effects of
041017 - Atorvastatin. ref SDS 15 JO6K
041019 - ..
041020 - On 131125 0005 research yielded public reporting Tim Russert, popular
041021 - television news commentator died from heart attack despite achieving
041022 - reduction of cholesterol LDL 68, below the "gold standard" for
041023 - coronary health; yet, his HDL 37 remained very low, and he continued
041024 - overweight (metabolic syndrome). ref SDS 15 RK6O
041026 - ..
041027 - On 131125 0005 research yielded public reporting coronary CT
041028 - angiography test measures calcium present in the arteries. Tim
041029 - Russert had the scan done in 1998 with a score of 210. It should be
041030 - 0. ref SDS 15 N73K Coronary computed tomography angiography (CTA)
041031 - allows coronary artery visualization and the detection of coronary
041032 - stenoses. In addition; it has been suggested as a novel, noninvasive
041033 - modality for coronary atherosclerotic plaque detection,
041034 - characterization, and quantification. ref SDS 15 VW3W
041036 - ..
041037 - On 131125 0005 research yielded public reporting HDL > 60 are
041038 - associated with a reduced risk of coronary artery disease (CAD). HDL
041039 - "scour" the walls of blood vessels cleaning out excess cholesterol
041040 - that otherwise might have been used to make the plaques that cause
041041 - CAD. ref SDS 15 4E6H
041043 - ..
041044 - On 131125 0005 research yielded public reporting clinical trials found
041045 - that increasing HDL with drugs does not yield benefits of regressing
041046 - atherosclerotic plaques. ref SDS 15 KG9F
041048 - ..
041049 - On 131125 0005 research yielded public reporting that aerobic exercise
041050 - (any exercise, such as walking, jogging or bike riding, that raises
041051 - your heart rate for 20 to 30 minutes at a time) may be the most
041052 - effective way to increase HDL levels in a way that does appear to
041053 - lower risk of heart disease. Evidence suggests the duration of
041054 - exercise, rather than the intensity, is the more important factor in
041055 - raising HDL choleserol. ref SDS 15 SH4J
041057 - ..
041058 - On 140213 0830 meeting at VA consider performing coronary CT
041059 - angiography (CCTA) test to evaluate regression of atherosclerosis
041060 - lesions based on labs showing elevated LDL-C, but also high HDL and
041061 - low triglycerides (TG), which could signal discordance, i.e., low
041062 - LDL-P, ref SDS 17 JZ4O, which is the healthiest condition for CVD
041063 - patients, shown by research on 131125 0005. ref SDS 15 FI3G
041065 - ..
041066 - On 151028 1000 Doctor Simpson advised he has received no
041067 - correspondence from the patient. This indicates correspondence is
041068 - incorrectly addressed, or that the VA is intercepting the doctor's
041069 - mail. ref SDS 30 NV5I
041070 -
041071 -
041072 -
041074 - ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Agenda for meeting...
041402 -
041403 - 1. Lab results...
041404 -
041405 - 1. HDL............................. Labcorp 73 VA 69
041406 - 2. Triglycerides................... Labcorp 61 VA 61
041407 - 3. LDL-C........................... Labcorp 98, VA 96
041408 - 4. Total Cholesterol............... Labcorp 183 VA 177
041409 - 5. TG/HDL ratio.................... Labcorp 0.8 VA 0.9
041410 - 6. LDL-P count..................... Labcorp 699
041411 - 7. LDL particle size............... Labcorp 20.9
041413 - ..
041414 - Doctor Simpson was pleased that hiking 240 miles the past 3 weeks
041415 - caused HDL 60 on 151027, ref SDS 29 5C7M, increased to HDL 73, which
041416 - improved on HDL 70 achieved last year, when Doctor Rao said patient
041417 - would not be able to increase HDL above 70, reported on 150213 0830,
041418 - ref SDS 19 ZM3I Doctor further Simpson noted advantages of TG 61
041419 - resulted in TG/HDL ratio < 1, and LDL-P 699 with LDL particle size
041420 - 20.9 (large that resists penetration of endothelial lining of blood
041421 - vessels), shown in blood tests, reported in another record on 160202
041422 - 1220. ref SDS 35 BE6O
041424 - ..
041425 - 8. Bilirubin elevated causing
041426 - frequent urination.............. Labcorp 1.7 VA 2.2
041428 - ..
041429 - 9. Potasium elevated possible
041430 - electrical problems to
041431 - heart........................... Labcorp 5.3 VA 5.0
041433 - ..
041434 - 10. WBC elevated indicates elevated
041435 - EPCs............................ Labcorp 11.3 VA 9.4
041437 - ..
041438 - 11. Glucose in range................ Labcorp 87 VA 104
041440 - ..
041441 - 12. Salt (NA)....................... Labcorp 147 VA 144
041442 -
041443 -
041444 -
041446 - ..
041447 - 2. CCTA on 151019, amended findings filed on 160113, ref SDS 33
041448 - A85F, says in part...
041450 - ..
041451 - "Coronary calcium score is calculated to be 1360," shown in
041452 - addendum to CCTA on 151019 0930, ref SDS 28 SU5O
041454 - ..
041455 - Given that Tim Russert (prominent NBC news reporter) died from
041456 - coronary problems with calcium score 210, reported in research on
041457 - 131125 0005, ref SDS 15 N73K, what is signigicance of calcium score
041458 - 1360 in this case?
041460 - ..
041461 - Since calcium score 1360 was not presented in the original report
041462 - filed on 151019, ref SDS 28 8Q6I, there is an implied finding this
041463 - presents no risk to the patient, since to withhold a life threatening
041464 - medical condition seems at least unprofessional. During a meeting
041465 - Doctor Elicker in Radiology Department expressly stated that calcium
041466 - buildup in bypassed blood vessels presents no health risk to the
041467 - patient of any kind, reported on 151203 1014. ref SDS 31 QW4K Doctor
041468 - Jha made similar representation a month later in a meeting on 160104
041469 - 0855. ref SDS 32 FF5K
041471 - ..
041472 - How high can calcium increase in bypassed blood vessels until a
041473 - rupture or other injurious event occurs?
041474 -
041476 - ..
041477 - 3. Research indicates coronary artery bypass grafts (CABGs) fail
041478 - and so have to be replaced after 7 - 15 years. CABG x4 in this
041479 - case occurred about 7 years ago on 091022 0700. ref SDS 4 156H
041481 - ..
041482 - Should Doctor Tseng, attending for CABG x4 on 091022, be
041483 - consulted to consider rate of failure in this case?
041485 - ..
041486 - The LAD graft was from the left internal mammary artery (LIMA)
041487 - attached to the subclavian. The other 3 grafts were from the
041488 - saphenous vein which Paula harvested from the right leg.
041489 - reported in Progress Notes on 091022, shown in the record on
041490 - 100928 0706. ref SDS 10 YI7K
041492 - ..
041493 - Does CCTA on 151019, indicate no evident risk of failure if HDL
041494 - 60+ is maintained?
041496 - ..
041497 - Since saphenous veins are weaker than coronary arteries, like
041498 - the LIMA, is there a risk of failure for 3 bypass that used
041499 - vein tissue from extended endurance exercise hiking 15 and 11
041500 - miles per day, 300 miles per month? Can we be overstressing
041501 - the vein bypass grafts in order to maintain HDL 60+?
041503 - ..
041504 - Doctor Simpson commented that medical profile in this case is the
041505 - healthiest patient he has ever had. He feels patient should not
041506 - worry about atherosclerosis, nor about saphenous vein bypass grafts
041507 - failing. He mentioned having had patients with saphenous grafts that
041508 - lasted 30 years.
041509 -
041511 - ..
041512 - 4. Atorvastatin 10 mg Ezetemibe 10 mg reduce 50% to every other
041513 - day.
041515 - ..
041516 - Statin treatments in this case have proven to cause frequent
041517 - urination that in turn causes dehydration, which then injures
041518 - feet with cracking, peeling, scaling, bleeding. This prevents
041519 - hiking needed to maintain HDL 60+ and TG 70- that lowers risk
041520 - of CVD by regressing and preventing atherosclerosis plaque.
041522 - ..
041523 - Atorvastatin has further caused recurrence of myopathy in left
041524 - shoulder over the past 5 months. Myopathy in left shoulder led
041525 - to abandoning Simvastatin in 2010?
041527 - ..
041528 - Recent efforts past 2 months, adding pushups to daily training,
041529 - seems to reduce myopathy pain in left shoulder.
041531 - ..
041532 - Omeprazole 20 mg prescribed to treat achalasia has same adverse
041533 - side effects. On 151204, Omeprazole was reduced 50% by taking
041534 - 20 mg every other day. This was suggested by Doctor Wisneski
041535 - in a meeting on 151005 1102. ref SDS 26 VH7O
041537 - ..
041538 - Do CCTA on 151019, showing complete regression atherosclerosis
041539 - in active circulatory system, 151019 0930, ref SDS 28 SU62, and
041540 - HDL 73, TG 61 results of lab on 160131, support eliminating
041541 - statin allowing cholesterol to rise above 300, and LDL-c to
041542 - rise above 200 even with HDL > 60 and TG < 70 and LDL-P size >
041543 - 20.5?
041545 - ..
041546 - Does CCTA on 151019, support reducing statins treatment 50%
041547 - allowing cholesterol to rise above 200, and LDl-c to rise above
041548 - 150 with HDL > 60 and TG < 70 and LDL-P size > 20.5?
041550 - ..
041551 - Doctor Simpson reduced statin treatment 50% to taking Atorvastatin 10
041552 - mg and Ezetimibe 10 mg every other day.
041553 -
041554 - [On 160207 1550 ordered refill for Atorvastatin. 160207
041555 - 1550, ref SDS 36 YZ3L
041557 - ..
041558 - 5. Hiking experiment to raise HDL 80; test again in 3 weeks.
041559 -
041560 - Evaluate effects continuing 15 mile hikes at current 15 - 16
041561 - minute miles.
041563 - ..
041564 - Evaluate doubling hikes to 26 miles per day on day of lab.
041566 - ..
041567 - Hiking experiment to maintain favorable HDL and TG levels with
041568 - less mileage in order to reduce side effects, save time?
041569 -
041571 - ..
041572 - 6. CCTA schedule in 12 months.
041574 - ..
041575 - Developed work plan for doing another CCTA OA 161019, evaluate
041576 - reduced statins.
041577 -
041579 - ..
041580 - 7. Next meeting with Doctor Simpson.
041581 -
041582 - Schedule follow up in 3/6 months to review progress toward
041583 - normalizing lipids (cholesterol 160, LDL-P < 1000, TG 50, HDL
041584 - 70).
041586 - ..
041587 - Scheduled next meeting with Doctor Simpaon in 3 months on 160504.
041588 -
041589 -
041590 -
041591 -
0416 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Medical Chart Progress Notes for Cardiology Meeting 160203
050403 - Progress Notes Cardiology Meeting 160203 Doctor Simpson
050404 - Doctor Simpson Progress Notes Cardiology Meeting 160203
050405 -
050406 - Follow up ref SDS 30 868G, ref SDS 27 PF5K.
050407 -
050408 - VA Progress Notes for meeting with health care providers are
050409 - available at...
050410 -
050411 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
050412 -
050423 -
050424 - 1. Date/Time: 03 Feb 2016 @ 1145
050425 - Note Title: CARDIOLOGY CLINIC ATTENDING NOTE (MED)
050426 - Location: San Francisco CA VAMC
050427 - Signed By: SIMPSON,PAUL C
050428 - Co-signed By: SIMPSON,PAUL C
050429 - Date/Time Signed: 03 Feb 2016 @ 1203
050431 - ..
050432 - 2. LOCAL TITLE: CARDIOLOGY CLINIC ATTENDING NOTE (MED)
050433 - STANDARD TITLE: CARDIOLOGY ATTENDING NOTE
050434 - DATE OF NOTE: FEB 03, 2016@11:45 ENTRY DATE: FEB 03, 2016@11:45:43
050435 - AUTHOR: SIMPSON,PAUL C EXP COSIGNER:
050436 - URGENCY: STATUS: COMPLETED
050437 -
050438 - *** CARDIOLOGY CLINIC ATTENDING NOTE (MED) Has ADDENDA ***
050444 - ..
050445 - 3. Most Recent VITAL SIGNS:
050446 - Height: 64.5 in [163.8 cm] (09/23/2015 15:32)
050447 - Weight: 188 lb [85.5 kg] (02/03/2016 09:12)
050448 - BMI: 31.8 (Obesity Level I)
050449 - Temp: 97.8 F [36.6 C] (10/05/2015 08:40)
050450 - Pulse: 78 (02/03/2016 09:12)
050451 - Comments:
050453 - ..
050454 - Resp: 16 (10/05/2015 08:40)
050455 - BP: 129/80 (02/03/2016 09:12)
050457 - ..
050458 - O2 Sat: 2/3/16 09:12:52 O2:97
050459 -
050460 -
050461 - 4. 70 swm returns to f/u cor CTA and use or not of statins.
050463 - ..
050464 - 5. CARD PROBLEMS:
050465 -
050466 - 1) CAD sp CABG here 10-22-09 (LIMA, SVG diag, ramus, PDA)
050467 - last TTE here 10-26-09 wnl
050468 - last seen CT Surg 11-19-09, never cards
050469 - cor CTA 10-19-15 all grafts open (by my discn w radiol, some lumps
050470 - proximal left SVGs, ca score >1000)
050472 - ..
050473 - CTA addendum states: Coronary calcium score is calculated to be
050474 - 1360.
050475 -
050476 - No significant calcified plaque is seen in the bypass grafts. All
050477 - the bypass grafts are opacified with contrast without evidence
050478 - for filling defect or wall calcifications.
050480 - ..
050481 - No calcification is seen in the aortic wall in the visualized
050482 - portions of the thoracic aorta. No ostial calcifications at the
050483 - origins of great vessels from the aortic arch.
050485 - ..
050486 - More Ca++ in proximal bypassed vessels w/o blood flow not
050487 - unexpected.
050488 -
050489 - 2) hyperlipidemia LDL 170 12-14-09; lately ok, then bad again
050490 - off statin, then better on low dose atorva 10 plus ezet.
050491 -
050492 - 3) overwt/obesity (BMI ~30)
050493 -
050494 - 4) statin SEs: freq urination, dry fet, pain left arm
050496 - ..
050497 - 6. OTHER:
050498 -
050499 - 1) achalasia sp ops
050500 - 2) LLE hematoma w cellulitis sp fall (adm here 9-23 to 9-25-15)
050501 - 3) recent fx R radius (same fall)
050503 - ..
050504 - 7. ASSESS:
050505 -
050506 - No change x better LDL back on statin. Clinically doing
050507 - excellent. CTA shows nothing of concern.
050509 - ..
050510 - 8. PLAN:
050511 -
050512 - He wants to drop back on statin and ezet to qod, and see what
050513 - happens. I don't think this is a good idea, and said so. I
050514 - suggest high statin and low LDL.
050516 - ..
050517 - Ezet and omep renewed.
050519 - ..
050520 - I will monitor the effects of his exp.
050521 - he will be walking a lot 15 miles qd or more.
050523 - ..
050524 - See agin 3 mos.
050525 - Labs ordered for then.
050526 - ASK RE ASA.
050528 - ..
050529 - 9. HPI:
050530 -
050531 - No change. walking a lot w/o sxs.
050533 - ..
050534 - Gets up 3-6 am often to walk, bed early am, so not much sleep.
050535 - one meal a day in evening, but healthy (fish, avocados, vegs).
050537 - ..
050538 - Learned today that wife of many years died of breast ca not too
050539 - long ago.
050541 - ..
050542 - 10. Active Medications:
050543 -
050544 - 1) ATORVASTATIN CALCIUM 20MG TAB TAKE ONE-HALF TABLET
050545 - ORALLY AT BEDTIME FOR CHOLESTEROL
050546 - 2) CLOTRIMAZOLE 1% TOP CREAM APPLY CREAM TOPICALLY TWICE
050547 - A DAY UNDER AFFECTED TOE
050548 - 3) FAMOTIDINE 20MG TAB TAKE ONE TABLET ORALLY AT BEDTIME
050549 - FOR STOMACH
050550 - 4) GAUZE PAD 4IN X 4IN 12-PLY STERILE USE GAUZE AS
050551 - DIRECTED TO COVER WOUND PACKING.
050552 - 5) KERLIX 4.5IN STERILE USE BANDAGE AS DIRECTED TO WRAP
050553 - LOOSELY AROUND WOUND.
050554 - 6) TAPE,MICROPORE 2IN 3M #1530-2 USE TAPE AS DIRECTED
050555 -
050556 - plus ezetimide 10 qd
050558 - ..
050559 - 11. Computerized Problem List is the source for the following:
050560 -
050561 - 1. History of coronary artery bypass grafting, 10/14/2015
050562 - Onset 10/00/2009
050563 - SFVA LIMA, SVGs diag, ramus, PDA
050564 - 4) Hyperlipidemia 10/14/2015
050565 - 5) Body mass index 30+ - obesity 10/14/2015
050566 - 6) Chronic ischemic heart disease 10/14/2015
050567 - 7) Esophageal Achalasia * (ICD-9-CM 530.0) 12/08/2009
050569 - ..
050570 - VS above ok.
050572 - ..
050573 - 12. Clinical Reminder Activity
050574 - MED REC NON PRIMARY CARE:
050575 - Current medications reviewed with patient/caregiver and reconciliation
050576 - of medications related to today's visit completed, including non-VA
050577 - medications and discrepancies, if identified, were addressed.
050578 - Medication changes and the importance of medication management were
050579 - reviewed with the patient/caregiver today based on individual needs.
050580 - Patient/caregiver acknowledged understanding of instructions as
050581 - stated. An updated list of reconciled medications has been provided
050582 - to the patient/caregiver.
050583 -
050584 - 13. /es/ Paul C. Simpson MD
050585 - Attending MD Cardiology, NPI 1548374093
050586 - Signed: 02/03/2016 12:03
050587 -
050588 - 14. 02/05/2016 ADDENDUM STATUS: COMPLETED
050589 -
050590 - Reviewed recent labs, K elevated at 5.0 non hemolized, Na ok.
050591 - Has previously been at this level, not on any meds that could
050592 - cause hyperkalemia, no renal dz, consider hypo aldo, RTA.
050593 - overdue for f/u, last seen 9/15. Will ask MSA to reschedule
050594 - and ask patient to come in for labs prior to this, looks Like
050595 - np rettberg has clinic in mid march.
050596 -
050597 - /es/ ALISON M LUDWIG, MD
050598 - Physician Chief, Medical Practice, NPI#1 UC# 50337
050599 - Signed: 02/05/2016 15:01
050601 - ..
050602 - 15. Receipt Acknowledged By:
050603 - 02/05/2016 15:57 /es/ MANITA MONROE
050604 - MSA
050605 - 02/08/2016 13:12 /es/ Lynn M OBrien, APRN
050606 - Infectious Disease Clinic, VA2451, NPI#:1114996980
050607 - 02/05/2016 15:13 /es/ Lauren B RETTBERG, NP Resident
050608 - San Bruno CBOC & Medical Practice, NPI 1073996773
050609 -
050610 - 02/05/2016 ADDENDUM STATUS: COMPLETED
050611 - called pt; left voicemail to schedule f/u appt
050612 -
050613 - /es/ MANITA MONROE
050614 - MSA
050615 - Signed: 02/05/2016 15:59
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