CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 17 0001, ref SDS 17 0000. ref SDS 15 0000.
040502 -
040503 -
040504 -
040505 -
040506 - [On 160820 0940 received in US Mail printed copy of letter
040507 - from Doctor Kim with Doctor Vora listed as co-author, and
040508 - confirming representation during the meeting today, that
040509 - Stanford Neuroscience 2nd opinion concludes MRI on 160618,
040510 - finding of "infarct" (stroke" is incorrect, in that MRI
040511 - imaging does not support finding of stroke. Stanford
040512 - Neuroscience 2nd opinion on cause of stroke symptoms still
040513 - pending. ref SDS 21 R66J
040515 - ..
040516 - [On 160921 1130 Doctor Lee meeting in GI Clinic at VA
040517 - Medical Center in Sacramento, said he did not authorize
040518 - Stanford Neuroscience 2nd opinion; he found on VA computer
040519 - system another Doctor Randall Lee working at UCSF Parnasus
040520 - campus, who likely approved 2nd opinion work by Stanford
040521 - Neuroscience; after reading 2nd opinion dated 160802,
040522 - Doctor Lee said he would make sure VA pays patient for the
040523 - cost of 2nd opinion work by Stanford Neuroscience.
040524 - ref SDS 28 1C6F
040525 -
040526 -
040527 -
040528 -
040529 -
040531 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Left the house at 1102 and arrived at 1220 for meeting with...
040902 -
040903 - Stanford Health Care
040904 - Neuroscience
040905 - 213 Quarry Road
040906 - Palo Alto, CA 94304
040907 - 650 725 5792 Option #2
040908 -
040909 - 650 723 6469
040911 - ..
040912 - This implemented the call from Claudia earlier this morning on 160802
040913 - 0917. ref SDS 17 WF5I
040915 - ..
040916 - Checked in and paid $855, agreed during the call with Claudia, shown
040917 - on 160802 0917. ref SDS 17 VO6O
040918 -
040919 - Encounter.................................... 131191460051
040920 - Guarantor ID................................. 101721020
040921 - Medical Record............................... 35808518
040922 - Authorization Code........................... 675962
040924 - ..
040925 - Paid 2nd opinion fee......................... $855
040927 - ..
040928 - Post expense ledger...
040929 -
040933 - ..
040934 - After paying for the 2nd opinion project, filled out patient packet,
040935 - received with the letter from Jesse earlier this morning, reported in
040936 - another record on 160802 0917. ref SDS 17 3P8I
040938 - ..
040939 - After filling out the section on patient medications, was called into
040940 - the care section for vitals. BP seemed high, perhaps reflecting
040941 - driving through heavy traffic, and reaching 100 MPH to arrive in time
040942 - for the meeting.
040944 - ..
040945 - Was then shown into an examination room.
040947 - ..
040948 - Setup c16 on a counter in the examination room, and showing the letter
040949 - submitted to Jesse on 160730 0926, ref SDS 15 WF5I, in order to orient
040950 - the team on scope of work, and background in the case.
040951 -
040952 -
040954 - ..
0410 -
0411 -
0412 - 1310
0413 -
041301 - At this time....
041302 -
041303 - Sun Kim, MD Fellow
041304 - Swapnil Mehta, Medical Student
041306 - ..
041307 - Asked Sun who at the VA authorized referral for 2nd opinion cited by
041308 - Claudia in her call earlier this morning and scheduling the exigent
041309 - meeting this afternoon, reported on 160802 0917. ref SDS 17 ND6N
041310 - Explained, the day before on 160801, Jesse advised in a telecon that
041311 - Stanford Neuroscience requires a referral from the VA as a condition
041312 - for performing 2nd opinion work in this case. ref SDS 16 1I7J
041314 - ..
041315 - Sun presented a document which showed patient identification at
041316 - Stanford Neuroscience...
041317 -
041318 - MRN............. 3580818
041319 - Encounter....... 131191460051
041320 - Provider........ Nirali Vora, MD
041321 - Department...... Neurology 3rd Floor
041322 - Ref Physician... Doctor Randall M Lee
041323 -
041324 - [On 160816 0800 Doctor Lee with GI Clinic at VAMC
041325 - Sacramento reported that he did not authorize referral for
041326 - 2nd opinion on stroke symptoms after EGD on 160617, from
041327 - Stanford Neuroscience and did not know there was a
041328 - consultation. ref SDS 20 7Z5N
041330 - ..
041331 - [On 160820 0940 letter from Stanford Neuroscience with 2nd
041332 - opinion shows cc sent to Doctor Randall M Lee. ref SDS 24
041333 - R66J
041335 - ..
041336 - [On 160921 0917 letter to Jesse notifies Stanford
041337 - Neuroscience that Doctor Lee in GI Clinic at VAMC
041338 - Sacramento advised that he did not make referral and did
041339 - not know a referral was made, and so requests that Stanford
041340 - Neuroscience submit documentation showing Doctor Lee made
041341 - referral from the VA for Stanford Neuroscience to perform
041342 - 2nd opinion work on stroke case. ref SDS 27 386R
041344 - ..
041345 - Sun asked about the case.
041347 - ..
041348 - Referred Sun to the letter submitted to Stanford Neuroscience on
041349 - 160730 0926, ref SDS 15 DW57, as shown on c16, and citing the record
041350 - when neurological deficits occurred on 160617 1637. ref SDS 1 5F6F
041352 - ..
041353 - Sun began reading through the letter. He then said he had already
041354 - read it, from a copy printed and received from Jesse this morning.
041355 - Sun had brought the printed letter 160730, with him.
041357 - ..
041358 - Sun asked to explain history of symptoms on 160617, verbally, as a
041359 - test of patient neurological status. He took notes, while the record
041360 - was presented again, as shown on 160617 1637. ref SDS 1 5F6F
041362 - ..
041363 - Asked Sun to show on the computer monitor in the examination room the
041364 - location in the MRI scan imaging where VA Neurology claims a stroke
041365 - occurred, reported on 160620 0707, ref SDS 4 LN8G, and which is
041366 - described in the radiology report as an "infarct," shown on 160618
041367 - 1348. ref SDS 2 IY8H
041369 - ..
041370 - Sun scrolled through the images and pointed to a location on the
041371 - computer screen, which he said is the reference to a stroke reported
041372 - in findings for MRI performed on 160618, in this case.
041374 - ..
041375 - Asked sun to present in Stanford's 2nd opinion the particular
041376 - sequence and image number showing this location.
041378 - ..
041379 - Sun advised this imaging is insufficient to identify a stroke, and
041380 - there is nothing else in the MRI imaging on 160618, that supports a
041381 - diagnosis of stroke. Sun then said the Neuroscience team believes
041382 - there was no stroke in this case.
041383 -
041384 - [On 160820 0940 received letter from Stanford Neuroscience
041385 - saying there is no evidence patient suffered stroke,
041386 - ref SDS 21 U14F, and that MRI on 160618 does not support
041387 - finding of stroke. ref SDS 21 OE7M
041389 - ..
041390 - Sun scrolled through many other of the MRI images pointing out what
041391 - appear as numerous white dots randomly, distributed throughout the
041392 - brain.
041394 - ..
041395 - He described these white dots as leptomeningeal inflammation.
041397 - ..
041398 - He asked if the VA has scheduled another MRI to test for resolution of
041399 - the inflammation after clinical symptoms resolved during the meeting
041400 - with Doctor Massa and Doctor Yoo, on 160620? ref SDS 4 TQ6L
041402 - ..
041403 - Explained having requested follow up MRI at that time on 160620 0707.
041404 - ref SDS 4 IU9K This request was confirmed in a letter to the medical
041405 - team the next day on 160621. ref SDS 5 D457
041407 - ..
041408 - On 160623 0830 letter from Doctor Yoo advised that VA Neurology
041409 - believes there is no utility to repeat imaging unless symptoms worsen
041410 - (to look for recurrent stroke). Hypothetically, if we DID get the
041411 - imaging, it would not provide any useful information in making new
041412 - recommendations care. ref SDS 6 SV5O
041413 -
041414 -
041415 -
041417 - ..
0415 -
0416 -
0417 - 1402
0418 -
041801 - Received call on the cellphone from Doctor Massa, reported fully in
041802 - another record on 160802 1404. ref SDS 18 WF5I
041804 - ..
041805 - Explained meeting is underway with Stanford Neuroscience, and will
041806 - call him back.
041808 - ..
041809 - Doctor Massa insisted on talking for at least a few moments, initially
041810 - asking what questions were preseted when we last met?
041811 -
041812 - [On 160820 0940 Stanford Neuroscience uses same language in
041813 - 2nd opinion letter that Doctor Massa presented in this
041814 - call, indicating Stanford team placed courtesy call to
041815 - Doctor Massa to alert them to their findings. ref SDS 22
041816 - JZ66
041818 - ..
041819 - Advised Doctor Massa the cellphone is on speaker mode to facilitate
041820 - collaboration with the Stanford team.
041822 - ..
041823 - Further advised Doctor Massa there have been many meetings with
041824 - Neurology, and a lot of correspondence presenting numerous questions.
041825 - The meeting today with Stanford Neuroscience is to determine the most
041826 - plausable cause of stroke symptoms so corrections can be made to
041827 - safely perform the next EGD scheduled on 160909, as discussed with
041828 - Doctor Massa on 160722 1304. ref SDS 10 6S4G Doctor Massa repeatedly
041829 - stated he did not have time to do this work, so Stanford Neuroscience
041830 - was hired to assist VA Neurology, reported in the letter to Stanford
041831 - Neuroscience on 160730 0926. ref SDS 15 DX31 The VA medical tea
041832 - received a copy of this letter.
041834 - ..
041835 - Doctor Massa explained that after he read his copy of the letter dated
041836 - 160730, to Stanford Neuroscience, he made another review of the case.
041837 - He said that VA Neurology has changed assessment of MRI on 160618, and
041838 - now believes that no stroke occurred. This reverses findings in the
041839 - MRI on 160618 1348. ref SDS 2 IY8H It further reverses guidance in
041840 - the Neurology letter to Doctor Lee on 160715, saying the patient is
041841 - released by Neurology for performing another EGD dilation. 160715
041842 - 1630, ref SDS 8 MO6F
041844 - ..
041845 - Doctor Massa said the next EGD scheduled on 160909, may have to be
041846 - delayed pending further review and release by Neurology.
041848 - ..
041849 - After this call, Doctor Sun performed another clinical neurology test,
041850 - as previously done many times beginning on 160617, reported in case
041851 - study on 160620 0707. ref SDS 4 1I4H
041853 - ..
041854 - Sun and Swapnil then left the room to confer with Doctor Vora.
041855 -
041856 -
041858 - ..
0419 -
0420 -
0421 - 1419
0422 -
042201 - Doctor Vora and the team came into the examination room.
042202 -
042203 - She is cordial, efficient, and knowledgeable. Doctor Vora confirms
042204 - Doctor Sun's initial advice that the MRI on 160818, shows no evidence
042205 - of stroke, per above. ref SDS 0 SU3H
042207 - ..
042208 - Asked Doctor Vora to explain preliminary opinion and or hunches on
042209 - what could have caused stroke symptoms reported on 160617 1637.
042210 - ref SDS 1 5F6F
042212 - ..
042213 - Doctor Vora and Doctor Sun seemed to both indicate that stroke
042214 - symptoms likely arose from EGD dilation procedure, based on
042215 - chronology, though at this time nothing has been identified to explain
042216 - precise causation.
042218 - ..
042219 - Asked about theory of baceteria virus infection from contaminated
042220 - instruments set out in the letter to the VA on 160727 0004,
042221 - ref SDS 11 SZ64, and submitted to Stanford Neuroscience in the
042222 - requesting 2nd opinion on 160730 0926? ref SDS 15 DW63
042224 - ..
042225 - Doctor Vora indicated virus infections typically take more time to
042226 - cause symptoms. Since the patient experienced possible stroke
042227 - symptoms within hours of completing the EGD Dilation procedure on
042228 - 160617, this seems conflicting with common experience of virus
042229 - infection. Her initial feeling is that if the gastroscope was
042230 - contaminated in this case, the follow on stroke symptoms would have to
042231 - arise from an uncommon virus, bacteria, etc.
042233 - ..
042234 - The doctor assured that more research is needed to fully investigate
042235 - EGD related causation in this case.
042237 - ..
042238 - She asked about personality changes?
042240 - ..
042241 - None come to mind.
042243 - ..
042244 - Doctor Vora noted the team's initial inquiry is focused on conscious
042245 - sedation.
042246 -
042247 - [On 160820 0940 letter from Stanford Neuroscience dated
042248 - today, 160802, and received 3 weeks later, says in part
042249 - that "... diffuse leptomeningeal enhancement! increased
042250 - vascularity most prominent in a culprit right frontal
042251 - region raises question of anesthetic-related changes...
042252 - ref SDS 23 JF86
042254 - ..
042255 - [On 160921 1130 meeting with Doctor Lee in GI Clinic at VA
042256 - Medical Center in San Francisco, the doctor advised
042257 - Stanford's 2nd opinion is helpful for establishing no
042258 - stroke actually occurred, and that stroke symptoms of
042259 - pervasive leptomeningeal enhancement likely resulted from
042260 - anesthesia-related changes. ref SDS 28 G89I
042262 - ..
042263 - She further presented a rough concept that the patient could have been
042264 - accumulating conditions of some kind from prior EGD procedures that
042265 - reached a critical stage after the recent EGD on 160617. It might
042266 - just be an innate, unique genetic condition for this patient. The
042267 - procedure on 160617, was then sufficient to cause stroke symptoms even
042268 - though prior procedures with the same normal protocol did not.
042269 -
042270 - [On 160907 1420 letter notifies medical team that
042271 - Triamcinolone may have caused stroke symptoms on 160617,
042272 - because dose over 3 month period accumulated to
042273 - significantly more than commonly given in this case.
042274 - ref SDS 26 BI60
042276 - ..
042277 - Reviewed background in this case, that stroke symptoms have no
042278 - explanation. Stanford Neuroscience was hired to investigate what
042279 - caused clinical stroke symptoms identified on 160617 1637, ref SDS 1
042280 - 5F6F, and findings in the MRI on 160618, ref SDS 2 WK7K, all as set
042281 - out in the letter to Stanford Neuroscience on 160730 0926. ref SDS 15
042282 - DW57 Medical team needs this explanation in time to guide next EGD
042283 - dilation procedure scheduled on 160909, because LESV seems to be
042284 - shutting down faster this cycle, explained in the letter to Doctor
042285 - Stewart on 160729 0119. ref SDS 12 DZ3Q Doctor Stewart is considering
042286 - a surgical solution to achalasia, but advised on 160705, that
042287 - neurology stroke problem must be resolved first. ref SDS 7 LN7M
042289 - ..
042290 - Doctor Vora advised that she feels confident that her 2nd opinion
042291 - review will identify the cause of stroke symptoms on 160617, and in
042292 - time to make corrections, if any are needed, for the next EGD dilation
042293 - procedure scheduled on 160617.
042295 - ..
042296 - This aligns with assurance from Doctor Abrams, Chief of Neurology at
042297 - VAMCSF, that VA will do everything necessary to determine what caused
042298 - stroke symptoms after EGD procedure on 160617, in order to assure
042299 - safety of doing further procedures, reported on 160619 0800.
042300 - ref SDS 3 SV54
042302 - ..
042303 - [On 160811 1546 Doctor Massa letter presents possible ways
042304 - EGD could have caused stroke symptoms and neurology
042305 - anomolies in the MRI on 160618, and notes "significant
042306 - possibility" that EGD caused stroke symptoms. ref SDS 19
042307 - KQ4J
042309 - ..
042310 - [On 160820 0940 received in US Mail printed copy of letter
042311 - from Doctor Kim with Doctor Vora listed as co-author, and
042312 - confirming representation during the meeting today, that
042313 - Stanford Neuroscience 2nd opinion concludes MRI on 160618,
042314 - finding of "infarct" (stroke" is incorrect, in that MRI
042315 - imaging does not support finding of stroke. Stanford
042316 - Neuroscience 2nd opinion on cause of stroke symptoms still
042317 - pending. ref SDS 21 R66J
042319 - ..
042320 - [On 160921 1130 Doctor Lee meeting in GI Clinic at VA
042321 - Medical Center in Sacramento, said he did not authorize
042322 - Stanford Neuroscience 2nd opinion; he found on VA computer
042323 - system another Doctor Randall Lee working at UCSF Parnasus
042324 - campus, who likely approved 2nd opinion work by Stanford
042325 - Neuroscience; after reading 2nd opinion dated 160802,
042326 - Doctor Lee said he would make sure VA pays patient for the
042327 - cost of 2nd opinion work by Stanford Neuroscience.
042328 - ref SDS 28 1C6F
042330 - ..
042331 - [On 160823 0920 Doctor Massa reported Triamcinolone
042332 - injection into LESV remains viable inquiry on cause of
042333 - stroke symptoms after EGD on 160617; he does not have time
042334 - to complete inquiry. ref SDS 25 SA5I
042336 - ..
042337 - Doctor Vora said determining what caused stroke symptoms after the EGD
042338 - on 160617, requires review of Progress Notes for the procedure and on
042339 - prior procedures to identify what may have been done differently on
042340 - 160617. She requested assistance accessing patient medical records at
042341 - VAMCSF to facilitate review by Stanford Neuroscience.
042342 -
042343 - [On 160907 1420 letter notifies medical team that
042344 - Triamcinolone may have caused stroke symptoms on 160617,
042345 - because dose over 3 month period accumulated to
042346 - significantly more than commonly given in this case.
042347 - ref SDS 26 BI60
042349 - ..
042350 - Advised that patient authorizes access to medical records to faciliate
042351 - review by Stanford Neuroscience.
042353 - ..
042354 - Asked about speaking with Doctor Lee to supplement record review,
042355 - since he performed the procedure, and he is listed as the referring
042356 - physician by Stanford Neuroscience in this case?
042358 - ..
042359 - Doctor Vora said she will review the documents, then speak with Doctor
042360 - Massa to see what information VA Neurology has developed toward
042361 - understanding what happened. Then she will contact Doctor Lee.
042363 - ..
042364 - Doctor Vora said that initially another MRI should be performed
042365 - immediately to see if the large number of white dots shown in the
042366 - first MRI on 160618, has fully resolved or at least declined, as
042367 - occurred with clinical stroke symptoms; or if it remains stable, or
042368 - even increased. Theory of the case diagnosing the cause of stroke
042369 - symptoms hinges on this first step of comparing another MRI with the
042370 - MRI performed on 160617.
042372 - ..
042373 - This aligns with discussion on 160620, asking Doctor Messa and Doctor
042374 - Yoo about doing another MRI to see if brain anomolies shown in the 1st
042375 - MRI on 160618, resolved after resolution of clinical stroke symptoms,
042376 - shown in the record on 160620 0707. ref SDS 4 IU9K The next day on
042377 - 160621, a letter to Doctor Yoo confirms request for another MRI.
042378 - ref SDS 5 D457 On 160715, again requested immediate MRI to test for
042379 - resolution of possible stroke indications in 1st MRI. ref SDS 8 3L3H
042380 - VA Progress Notes present work plan to perform no-rush conventional
042381 - cerebral angiogram, and if results are normal then order another MRI.
042382 - ref SDS 8 TW4N Patient request for immediate MRI was confirmed in
042383 - another letter on 160717 2227. ref SDS 9 GW50
042385 - ..
042386 - We considered the earlier call with Doctor Massa, received with Doctor
042387 - Kim and Swapnil in the room, per above, and that I suggested the MRI
042388 - might be performed this Friday, the same day currently scheduled to
042389 - perform studies on both knees. ref SDS 0 S36F
042391 - ..
042392 - Doctor Vora indicated this would expedite Stanford's 2nd opinon
042393 - review.
042395 - ..
042396 - The doctor further explained that the MRI should be performed with a
042397 - particular scope protocol in order to yield results that facilitate
042398 - optimum analysis in this case.
042400 - ..
042401 - Suggested that she send a letter to Doctor Massa to convey this
042402 - requirement.
042404 - ..
042405 - Doctor Vora said Stanford Neruoscience follows strict procedures for
042406 - implementing HIPPA regulations to protect patient privacy by avoiding
042407 - electronic transmission of communications. She will call Doctor Massa
042408 - to collaborate on developing the scope of the MRI, and other matters
042409 - in the case.
042411 - ..
042412 - Asked if the risk of email intercept also occurs with telephone
042413 - calls? We read so much in the papers about CIA, IRS, DOD, Sony, FBI,
042414 - Hillary, everybody's communications have been intercepted.
042416 - ..
042417 - In this case, the patient has waived HIPAA regulations on protecting
042418 - patient privacy in this case, and in order to permit using
042419 - conventional electronic mail (i.e., email) because time and accuracy
042420 - are of the essence solving critical health issues. Written
042421 - communication is more accurate that verbal telephone calls by orders
042422 - of magnitude.
042424 - ..
042425 - An example is the letter on 160715, from Doctor Yoo in Neurology at
042426 - VAMCSF, to Doctor Lee in GI at VAMC Sacramento, saying in part...
042427 -
042428 - Dear Dr Lee,
042429 -
042430 - I wanted to touch base regarding Mr Welch, a patient I've had
042431 - the pleasure of seeing recently both on the inpatient service
042432 - and in clinic. He asked me to communicate with you regarding
042433 - the issue of his recent procedure resulting in his stroke and
042434 - cleared me to e-mail you. He is CC'd on this letter.
042435 - ref SDS 8 MM8K
042437 - ..
042438 - There are already hundreds of correspondence, Progress Notes, labs and
042439 - test results posted on the Internet by the patient that expedite
042440 - communication and facilitate collaboration, so everyone has common
042441 - access for timely, accurate understanding. This resource is available
042442 - to the Stanford Neuroscience team.
042444 - ..
042445 - Doctor Vora seemed to say she would get in trouble from her boss, if
042446 - she accepted the patient waiver, to communicate efficiently on even a
042447 - very urgent matter, as involved here.
042449 - ..
042450 - What about looking at the Internet. The records are already there.
042451 - Does Stanford forbid doctors from checking the Internet?
042453 - ..
042454 - The doctor asked me to obtain a CD of the MRI and hand carry to
042455 - Stanford Neruoscience. She said if we wait for the bureaucracy at the
042456 - VA and at Stanford to transmit MRI results, this could take precious
042457 - days or weeks, because sometimes things get lost.
042459 - ..
042460 - Asked why not just transmit the MRI results attached to an email?
042462 - ..
042463 - The doctor said she would get in trouble expediting the work, because
042464 - email presents a small risk to patient privacy.
042466 - ..
042467 - Advised again this right has been waived in order to secure the right
042468 - to comprehensive health care in time to be effective, shown by Doctor
042469 - Yoo's letter to Doctor Lee on 160715, per above. ref SDS 0 SB9M
042471 - ..
042472 - Doctor Vora said she is still worried about this, so could the
042473 - patient just get in the car and drive 60 miles to deliver the CD,
042474 - then get back in the car and drive 60 miles to go home.
042476 - ..
042477 - Assured the team, they will be fully supported in every way.
042479 - ..
042480 - Doctor Vora requested a call on Thursday, to remind the team about
042481 - following up with Doctor Massa discussing details of VA analysis to
042482 - date.
042484 - ..
042485 - Again, explained it is all on the Internet.
042487 - ..
042488 - Thanked Doctor Vora and Doctor Kim, for a productive meeting, and look
042489 - forward to their findings and recommendations.
042491 - ..
042492 - Doctor Vora said that Swapnil will do another test after she and
042493 - Doctor Kim leave the examination room, and then the meeting will be
042494 - over.
042496 - ..
042497 - Thanked Doctor Vora and Doctor Kim for a productive meeting, and said
042498 - there findings on what caused stroke symptoms will greatly aid health
042499 - care in this case.
042501 - ..
042502 - After Doctor Vora and Doctor Kim left, Swapnil did another set of
042503 - mental tests - about 20 questions, that seemed similar to the SATs for
042504 - admission to Stanford. For example...
042505 -
042506 - 1. Examine a pattern of symbols connected in a drawing, and
042507 - complete connections of remaining symbols applying criteria
042508 - evident from the initial connection.
042510 - ..
042511 - 2. Subtract 7 from 92 - what is the result? Repeated 3 or 4
042512 - times.
042514 - ..
042515 - 3. Repeat moderately complex sentence.
042517 - ..
042518 - 4. Remember series of disconnected words, i.e., Swapnil said
042519 - them, and asked the patient to repeat them.
042521 - ..
042522 - 5. After doing several other test questions, Swapnil asked again
042523 - to repeat the words initially presented minutes earlier.
042525 - ..
042526 - On this test, could not remember anything. Advised that SDS was
042527 - developed to aid accurate memeory, see POIMS. ref OF 7 3742
042528 -
042529 -
042530 -
042531 -
042532 -
042533 -
042534 -
042535 -
042536 -
042537 -
042538 -
042539 -
042540 -
042541 -
042542 -