CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 17 0000. ref SDS 8 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie has a slight temperature today, 99.4.  Blood pressure is also
040902 - elevated.  There may have a problem with Kaiser's equipment.  Millie's
040903 - forehead was not warm.  At home after the examination her temperature
040904 - was normal, 97.6.
040906 -  ..
040907 - The doctor initially asked if Millie is feeling better today, less
040908 - anxious now that Kaiser has begun paying for the referral to UCSF?
040909 - Previously, on 070921 the doctor prescribed treatment for anxiety
040910 - caused by delays paying for treatment, and threats of UCSF terminating
040911 - care. ref SDS 8 QY9V  At that time, he further made a referral to
040912 - mental health, ref SDS 8 QY54,
040914 -  ..
040915 - Millie said Kaiser has not notified her that Kaiser has started making
040916 - payments for her treatment on referral at UCSF.  On 071030 UCSF said
040917 - demands for payment from Millie would be deferred pending review by
040918 - Kaiser, ref SDS 12 WZ5J; however, the next day on 071031 Millie
040919 - received notices from UCSF in the mail that treatment would be
040920 - terminated and collection action against Millie would commence because
040921 - Kaiser had not paid $202.65. ref SDS 14 KM4J  Paula, Kaiser's MCRC
040922 - unit case manager, called 2 days ago on 071114 saying she has not
040923 - received documentation from UCSF needed to process payments.
040924 - ref SDS 16 NE5P
040926 -  ..
040927 - A letter on 071030 requested UCSF submit documents to Kaiser required
040928 - for timely payments. ref SDS 12 JA4S  This aligns with UCSF's many
040929 - letters to Millie demanding immediate payment, e.g., on 071026,
040930 - ref SDS 11 SU5V, and subsequent notice of terminating treatment on
040931 - 071031. ref SDS 14 KM4J  On 071031 Paula called and requested
040932 - assistance getting documentation from UCSF to expedite payment for
040933 - Millie's treatment. ref SDS 13 NT3J  A week or so ago, on 071105 Paula
040934 - clarified scope of documentation required from UCSF, and reported
040935 - continuing delays getting documents from UCSF. ref SDS 15 K37Q
040937 -  ..
040938 - Paula called again this afternoon and advised that UCSF has still not
040939 - submitted documents required to process payments, continuing delays
040940 - resolving partial and conflicting data from UCSF, reported on 071114.
040941 - ref SDS 16 NE5P  She scheduled a call tomorrow for further assistance
040942 - using the doctor patient partnership proposed in the letter to Kaiser
040943 - on 071105. ref SDS 15 K44S
040945 -  ..
040946 - Millie related having received several more letters from UCSF
040947 - demanding payment under threat of terminating treatments, reported
040948 - previously on 071105, ref SDS 15 K39X, citing the record on 071031.
040949 - ref SDS 14 KM4J  As a result, anxiety remains elevated, shown by
040950 - vitals today.
040951 -
040952 -        [On 071126 due to a fax machine malfunction Kaiser has still
040953 -        not received documents requested from UCSF to substantiate
040954 -        billing charges for Millie's care, ref SDS 19 H67R; Paula
040955 -        called to obtain case history from the patient. ref SDS 19 OS4N
040957 -         ..
040958 -        [On 071128 Kaiser Appeals Committee approved payment for
040959 -        Millie's care on referral to UCSF. ref SDS 20 JZ5R
040961 -  ..
040962 - The doctor said he has been advised that Kaiser has begun processing
040963 - payments for Millie's care on referral to UCSF ordered on 070105; and,
040964 - that today, he submitted another authorization to replace the original
040965 - filed on 070119, but evidently lost in Kaiser's system, reported on
040966 - 070917, ref SDS 6 E197, and again on 071030. ref SDS 12 FM6H  There
040967 - seemed to be discussion today of Kaiser providing Medigap coverage in
040968 - this case, similar to research on 070917. ref SDS 6 EZ56
040970 -         ..
040971 -        [...below, Kaiser's Medical Chart reports authorization for
040972 -        Millie's treatment on referral was submitted again by the
040973 -        doctor. ref SDS 0 U63W
040975 -         ..
040976 -        [On 071126 Paula reported further problems finding documents
040977 -        for case management. ref SDS 19 DN5H
040979 -  ..
040980 - Submission of the doctor's authorization for treatment on referral to
040981 - UCSF aligns with Paula's plan proposed on 071030, ref SDS 12 FN4N, to
040982 - replace the authorization submitted by the doctor on 070119.
040983 - ref SDS 3 4R4M  At that time on 071030, Paula indicated that Kaiser's
040984 - Appeals Committee has authority to order submission of the doctor's
040985 - authorization for treatment on referral to UCSF. ref SDS 12 0G7J  At
040986 - this time there is nothing in the record showing this has actually
040987 - been done.
040989 -         ..
040990 -        [On 071128 Paula advised that the Kaiser Appeals Committee
040991 -        approved payment for Millie's care on referral to UCSF.
040992 -        ref SDS 20 JZ5R
040994 -  ..
040995 - The doctor examined IBC rash.  Concurred with report on examination
040996 - yesterday finding stable to subsiding condition on the left arm and
040997 - main chest area.  Observed stable to possibly slightly worse condition
040998 - on the right breast and a thin linke arching across the upper left
040999 - chest.  These findings after nearly a year of treatment demonstrate
041000 - strong response with minimal side effects that have enabled Millie to
041001 - experience life with normal vitality and greater vigor than most
041002 - people in there 70s.  Since prior treatments have lasted less than 6
041003 - months and have caused severe debilitating side effects, the current
041004 - treatment at UCSF has been a miracle for Millie.
041006 -  ..
041007 - Concurred with continuing cetuximab treatment.
041009 -  ..
041010 - Millie mentioned Jackie's plan during the meeting yesterday at UCSF to
041011 - order the next CT test in time for starting cycle #12 on 071213, which
041012 - requires doing the test at Kaiser OB 071210. ref SDS 17 EZ48  The
041013 - doctor said he will order the test when UCSF submits the request.
041014 -
041015 -            [On 071130 notified Jackie about ordering CT test for OB
041016 -            071210. ref SDS 21 NL7T
041017 -
041018 -
041020 -         ..
041021 -    1.  Visit Report #2 11/16/07
041031 -         ..
041032 -    4.  Received:
041033 -        11/16/07 4:25 PM
041035 -         ..
041036 -    5.  This is a 71 year old woman with a history of inflammatory
041037 -        cancer of left breast who was initially diagnosed 03/04/02.
041038 -        She had recurrent disease noted initially in the cervical LN's
041039 -        03/03/04.  She has been treated on several salvage regimes.  On
041040 -        E2100 Study with Avastin, she had a PE noted on CT 11/03/2004.
041041 -        She was placed on anticoagulation therapy for one year.  Then,
041042 -        because of progression of disease, the patient was started on
041043 -        Taxotere and Xeloda 4/15/05.  She had a total of 8 cycles
041044 -        ending 9/16/05.  She had a palliative left mastectomy performed
041045 -        10/21/05.  Then her left chest lesions began expanding again.
041046 -        The patient started Taxotere and Xeloda again 07/21/06 for 7
041047 -        cycles. She was started on a Clinical Trial 02/01/07 at UCSF
041048 -        and was randomized to the Erbitux only (no Carbo) Arm.  Patient
041049 -        is her for follow up.  Still has a very dry rash.
041051 -         ..
041052 -    6.  Current medications include:
041053 -
041054 -        TIMOLOL MALEATE 0.5% EYE DR
041055 -        WARFARIN 4MG TABLETS
041056 -        ACYCLOVIR 800MG TABLETS
041057 -        LORAZEPAM 1 MG TABLETS
041058 -        ERBITUX
041060 -         ..
041061 -    7.  PE:
041062 -
041063 -        Performance Status: 0
041064 -        Chest wall: decreased erythema on lower left chest wall
041065 -        Ext: LUE edema with patch of erythema involving upper arm;
041066 -        LUE measured at 31 cm
041067 -
041068 -             [On 080118 doctor reports increased erythema on lower left
041069 -             chest wall. ref SDS 22 1Z6O
041071 -         ..
041072 -    8.  Lab:
041073 -
041074 -        Albumin 4.3 g/dL
041075 -        BUN 13 mg/dL
041076 -        Magnesium 1.7 mg/dL
041077 -        Calcium 9.2 mg/dL
041078 -        Chloride 103 mEq/L
041079 -        CO2 25 mEq/L
041080 -        Creatinine 0.57 mg/dL
041081 -        Glucose Random 133 mg/dL
041082 -        Potassium 3.9 mEq/L
041083 -        Sodium 138 mEq/L
041084 -        Protein, Total 6.6 g/dL
041086 -  ..
041087 - These results are from a test at Kaiser on 071017, received from
041088 - Kaiser on 071023. ref SDS 10 LI8O
041090 -  ..
041091 - Medical Chart continues...
041092 -
041093 -        AST (SGOT) 31 U/L
041094 -        ALT (SGPT) 18 U/L
041095 -        Alkaline Phos 66 U/L
041096 -        Bili, Tot Adult 0.6 mg/dL
041098 -         ..
041099 -        PT, Patient H 23.2 Sec
041100 -        PT INR 2.3 Ratio
041102 -         ..
041103 -        WBC 4.3 K/uL
041104 -        RBC 4.56 M/uL
041105 -        Hemoglobin 13.9 g/dL
041106 -        Hematocrit 41.0 %
041107 -        MCV 90 fL
041108 -        RDW 12.7 %
041109 -        Plt 218 K/uL
041110 -
041112 -         ..
041113 -        CA 15-3
041114 -        ----------
041115 -        75 H
041116 -        74 H
041117 -        56 H
041118 -        52 H
041119 -        55 H
041120 -        56 H
041121 -        52 H
041122 -        68 H
041123 -        56 H
041124 -        74 H
041126 -  ..
041127 - Kaiser's medical chart can be strengthened by adding dates and source
041128 - for lab tests to correlate with test results shown above.
041130 -  ..
041131 - Kaiser reporting CA 15-3 75 ignores testing at UCSF yesterday on
041132 - 071115 that shows CA 15-3 43, ref SDS 18 A16M, increased from prior
041133 - test at UCSF on 070920 showing CA 15-3 38. ref SDS 7 A16M
041134 -
041135 -            [On 080118 meeting at Kaiser medical chart continues to
041136 -            show only results from tests at Kaiser and ingores
041137 -            continuing testing at UCSF. ref SDS 22 417N
041139 -  ..
041140 - Annomolous cancer marker tests in Kaiser's medical chart today
041141 - reflects patient history.  One set of tests were performed at Kaiser
041142 - on 071017 because the patient hoped this would resolve billing issues
041143 - between Kaiser and UCSF which let to UCSF threatening to terminate
041144 - treatment, reported on 071031. ref SDS 14 KM4J  Tests at Kaiser use a
041145 - different calibration method from tests at UCSF for the cancer marker.
041146 - Results of the test received from Kaiser on 071023 show CA 15-3 75.
041147 - ref SDS 10 JL41
041149 -  ..
041150 - Medical Chart continues...
041151 -
041152 -    9.  Imaging:
041153 -
041154 -        09/30/07 CT ABDOMEN, PELVIS, THORAX W CONTRAST
041155 -        05/20/07 CT THORAX, ABDOMEN, PELVIS W CONTRAST - no change
041156 -        12/27/06 BASE SKULL TO MIDTHIGH PET/CT
041157 -        10/16/06 HAND, TWO VIEWS
041158 -        10/13/06 MAMMOGRAPHY UNILATERAL
041159 -        07/08/06 MRI BRAIN WO/W CONTRAST(STD)- negative
041161 -         ..
041162 -   10.  Imp:
041163 -
041164 -        1. Metastatic breast cancer (IBC)lung, lymph node and chest wall
041165 -        2. LUE lymphedema improved
041166 -        3. Hx of PE on Warfarin INR 2-3
041167 -        4. Rash stable
041169 -         ..
041170 -   11.  Plan:
041171 -
041172 -        1. Continue Clinical Trial on Erbitux
041173 -        2. UCSF to add Carbo if she progresses
041174 -        3. Mental Health referral
041175 -        5. Continue Ativan for panic attacks
041176 -        6. Repeat CT's 2 weeks
041177 -        7. Outside Authorization for UCSF Clinical Trial submitted
041178 -        8. RTC 8 weeks
041180 -  ..
041181 - Authorization for Millie's treatment on referral to UCSF reported in
041182 - the Medical Chart was explained by the doctor, per above. ref SDS 0
041183 - BO6L
041185 -         ..
041186 -   12.  ROBERT ALLSTON JOHNSON MD 11/16/2007 3:54 PM
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