Question: i would like to upload the medical records for my sister in law who just had colon cancer. she had the tumor remove and apparently several lymph nodes remove and some were cancerous. so my questions would be, why did they remove this number of lymph nodes, why this amount of colon removed and a good analysis of what she had done and review. i want to upload her info

PatientJOYCE KUZMAAlias
Date of birthFebruary 4, 1950 SexFemale RaceBlack or XXXXXXX AmericanEthnicityNot Hispanic or Latino Preferred LanguageEnglish

Contact info Primary Home:
1042 XXXXXXX LN
Bethpage, TN 37022, US
Tel: (615)766-2704
Patient IDs0000 Ascension Enterprise Solution Architecture
`

Document Id
     

6ed55c00-4683-11e9-931f-00155d7b2c05

Document Created:
     

March 14, 2019, 13:03:12, EST

Performer (primary care physician)
     

No PCP

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

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Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (admitting physician)
     

MARK UHL

Contact info
     

Address and Telecom information not available
          

Performer (admitting physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Author
     

InterSystems HealthShare

Contact info
     

Work Place:
One Memorial Drive XXXXXXX MA 02142, US
Tel: (617) 621-0600

Office contact
     

Maganti XXXXXXX

Contact info
     

Address and Telecom information not available

Legal authenticator
     

HealthShare InterSystems of signed at March 14, 2019, 13:03:12, EST

Contact info
     

Work Place:
One Memorial Drive XXXXXXX MA 02142, US
Tel: (617) 621-0600

Document maintained by
     

Ascension Enterprise Solution Architecture

Contact info
     

Work Place:
One Memorial Drive XXXXXXX MA 02142, US
Tel: (617) 621-0600
Table of Contents

Allergies, Adverse Reactions, Alerts
Medications
Problems
Procedures
Results
Encounters
Payers
Social History
Vital Signs

Allergies, Adverse Reactions, Alerts

Allergy Name
     

Allergy Type
     

Status
     

Severity
     

Reaction(s)
     

Onset Date
     

Inactive Date
     

Treating Clinician
     

Comments

No Known Medication Allergies
     

DRUG
     

Active
                              
Medications

Ordered Medication Name
     

Filled Medication Name
     

Start Date
     

Stop Date
     

Current Medication?
     

Ordering Clinician
     

Indication
     

Dosage
     

Frequency
     

Signature (SIG)
     

Comments
     

Components

Acetaminophen 325 MG / Hydrocodone Bitartrate 5 MG Oral Tablet [Norco]
     

Acetaminophen 325 MG / Hydrocodone Bitartrate 5 MG Oral Tablet [Norco]
     

2019-02-11 06:35:00
          

Yes
     
XXXXXXX XXXXXXX
          

1tab
     

q6hrs
          

Hospital Only: For suspected Oversedation, refer to Oversedation Reversal Policy
     

Nonformulary Medication_Ginseng
     

Nonformulary Medication_Ginseng
     

2019-01-30 14:41:00
          

Yes
               

1tab
     

QDay
               

Garlic preparation
     

Garlic preparation
     

2019-01-30 14:39:00
          

Yes
                                   

Garlic preparation Oral Tablet
     

Garlic preparation Oral Tablet
     

2019-01-30 14:39:00
          

Yes
               

1tab
     

QDay
               

Calcium Carbonate / Cholecalciferol Oral Tablet [Os-Cal 500 with D]
     

Calcium Carbonate / Cholecalciferol Oral Tablet [Os-Cal 500 with D]
     

2019-01-30 14:38:00
          

Yes
               

1tab
     

QDay
               

Nonformulary Medication_Magnesium
     

Nonformulary Medication_Magnesium
     

2019-01-30 14:36:00
     

2019-02-06 14:36:00
     

Yes
               

1tab
     

QDay
               

Trazodone Hydrochloride 100 MG Oral Tablet
     

Trazodone Hydrochloride 100 MG Oral Tablet
     

2019-01-30 14:35:00
          

Yes
               

100mg
     

qBedtime
               

Levothyroxine Sodium 0.05 MG Oral Tablet
     

Levothyroxine Sodium 0.05 MG Oral Tablet
     

2019-01-30 14:35:00
          

Yes
               

50mcg
     

QDay
               

Omeprazole
     

Omeprazole
     

2019-01-30 14:34:00
          

Yes
               

40mg
     

QDay
               
Problems

Condition Name
     

Condition Details
     

Condition Category
     

Status
     

Onset Date
     

Resolution Date
     

Last Treatment Date
     

Treating Clinician
     

Comments

Palpitations
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

GERD - Gastro-esophageal reflux disease
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Hiatal hernia
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Cancer
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Hypothyroidism
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Asthma
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Arthritis
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Urinary incontinence
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          
Procedures

Procedure
     

Date / Time Performed
     

Performing Clinician
     

Device

COLECTOMY LAPAROSCOPIC1
     

2019-02-07 12:04:00
          

Resection of Right Large Intestine, Percutaneous Endoscopic Approach
     

2019-02-07 00:00:00
     

12378
     

Colonoscopy 1/2019
               

Tubal ligation
               
Results

Test Description
     

Test Time
     

Test Comments
     

Text Results
     

Atomic Results
     

Result Comments

HCT
     

2019-02-10 03:50:06
               



Test Item
     

Value
     

Reference Range
     

Comments

Hct (test code = 01849)
     

29.5 %
     

36.0-48.0
     
     

BMP
     

2019-02-09 05:36:57
               



Test Item
     

Value
     

Reference Range
     

Comments

Sodium (test code = 16169)
     

138 mmol/L
     

136-145
     

Potassium (test code = 15665)
     

4.1 mmol/L
     

3.4-5.1
     

Chloride (test code = 13289)
     

105 mmol/L
     

98-110
     

CO2 (test code = 13385)
     

26 mmol/L
     

21-32
     

Glucose Level (test code = 14729)
     

88 mg/dL
     

74-106
     

BUN (test code = 12929)
     

8 mg/dL
     

6-20
     

Creatinine Level (test code = 13553)
     

0.7 mg/dL
     

0.5-1.2
     

AGAP (test code = 10395)
     

8.0
          

Calcium, Serum (test code = 13025)
     

8.4 mg/dL
     

8.7-10.4
     

Creatinine Clearance (C - G Modified) (test code = 10371)
     

77.5 mL/min
          

This Creatinine Clearance calculation is an estimate for classification purpose
s only and should not be the only factor used in patient management decisions.
The Creatinine Clearance is a calculation valid for adults over 18 years with
adjustments for age, sex and weight. The calculation is not valid for patients
with changing renal function or patients on dialysis.
OBESITY WT. ADJUSTMENT USED
CREATININE VALUE FOR THIS PATIENT WAS LESS THAN 0.8, THEREFORE CREATININE VALUE
0.8 WAS USED IN THE CREATININE CLEARANCE CALCULATION.

Glomerular Filtration Rate (MDRD) (test code = 10089)
     

83 mL/min/1.73 m2
          

The GFR is calculated using the MDRD formula and is valid for adults over 18 yea
rs with adjustments for age, sex, and race. The calculation is not valid for pa
tients on dialysis or with rapidly changing kidney function. Patients with GFR
less than 60 are defined as having chronic kidney disease. A grading system o
f decreased kidney function has been proposed: 90 - 60 mild, 59 -30 moderate, 29
-15 severe.
     

CBC w/o Diff
     

2019-02-09 05:01:09
               



Test Item
     

Value
     

Reference Range
     

Comments

WBC (test code = 02281)
     

5.6 x1000/mm3
     

4.5-10.3
     

RBC (test code = 02017)
     

3.38 x0000/mm3
     

4.20-5.40
     

Hgb (test code = 01393)
     

8.8 gm/dL
     

12.0-16.0
     

Hct (test code = 01849)
     

29.3 %
     

36.0-48.0
     

MCV (test code = 00003)
     

87 fl
     

78-98
     

MCH (test code = 00005)
     

26.0 pg
     

26.0-34.0
     

MCHC (test code = 00007)
     

30.0 gm/dL
     

32.0-36.0
     

RDW (test code = 03655)
     

13.1 %
     

11.5-14.5
     

Platelet (test code = 01801)
     

200 x1000/mm3
     

150-500
     
     

BMP
     

2019-02-08 06:01:54
               



Test Item
     

Value
     

Reference Range
     

Comments

Sodium (test code = 16169)
     

140 mmol/L
     

136-145
     

Potassium (test code = 15665)
     

5.1 mmol/L
     

3.4-5.1
     

Chloride (test code = 13289)
     

108 mmol/L
     

98-110
     

CO2 (test code = 13385)
     

27 mmol/L
     

21-32
     

Glucose Level (test code = 14729)
     

85 mg/dL
     

74-106
     

BUN (test code = 12929)
     

10 mg/dL
     

6-20
     

Creatinine Level (test code = 13553)
     

0.7 mg/dL
     

0.5-1.2
     

AGAP (test code = 10395)
     

4.0
          

Calcium, Serum (test code = 13025)
     

8.6 mg/dL
     

8.7-10.4
     

Creatinine Clearance (C - G Modified) (test code = 10371)
     

77.5 mL/min
          

This Creatinine Clearance calculation is an estimate for classification purpose
s only and should not be the only factor used in patient management decisions.
The Creatinine Clearance is a calculation valid for adults over 18 years with
adjustments for age, sex and weight. The calculation is not valid for patients
with changing renal function or patients on dialysis.
OBESITY WT. ADJUSTMENT USED
CREATININE VALUE FOR THIS PATIENT WAS LESS THAN 0.8, THEREFORE CREATININE VALUE
0.8 WAS USED IN THE CREATININE CLEARANCE CALCULATION.

Glomerular Filtration Rate (MDRD) (test code = 10089)
     

83 mL/min/1.73 m2
          

The GFR is calculated using the MDRD formula and is valid for adults over 18 yea
rs with adjustments for age, sex, and race. The calculation is not valid for pa
tients on dialysis or with rapidly changing kidney function. Patients with GFR
less than 60 are defined as having chronic kidney disease. A grading system o
f decreased kidney function has been proposed: 90 - 60 mild, 59 -30 moderate, 29
-15 severe.
     

CBC w/o Diff
     

2019-02-08 05:43:30
               



Test Item
     

Value
     

Reference Range
     

Comments

WBC (test code = 02281)
     

7.2 x1000/mm3
     

4.5-10.3
     

RBC (test code = 02017)
     

3.74 x0000/mm3
     

4.20-5.40
     

Hgb (test code = 01393)
     

9.8 gm/dL
     

12.0-16.0
     

Hct (test code = 01849)
     

32.2 %
     

36.0-48.0
     

MCV (test code = 00003)
     

86 fl
     

78-98
     

MCH (test code = 00005)
     

26.2 pg
     

26.0-34.0
     

MCHC (test code = 00007)
     

30.4 gm/dL
     

32.0-36.0
     

RDW (test code = 03655)
     

13.2 %
     

11.5-14.5
     

Platelet (test code = 01801)
     

219 x1000/mm3
     

150-500
     
     

bAddendum
     

2019-02-07 00:00:00
          

Patient KUZMA, XXXXXXX

Name:
DOB: 2/4/1950
Accession: BS-19-0000

Recieved Date/Time:

2/7/2019 14:49 CST


DIAGNOSIS
RIGHT COLON, TERMINAL ILEUM AND APPENDIX, RESECTION:
MODERATELY DIFFERENTIATED ADENOCARCINOMA, MEASURING 2.6 CM IN GREATEST
DIMENSION, INVADING INTO THE MUSCULARIS PROPRIA, MARGINS NEGATIVE FOR
DYSPLASIA OR MALIGNANCY; 3 OF 26 LYMPH NODES INVOLVED BY METASTATIC
ADENOCARCINOMA; TUBULAR ADENOMA AT THE ILEOCECAL VALVE; SESSILE SERRATED
ADENOMA IN THE ASCENDING COLON; APPENDIX WITH FIBROUS OBLITERANS OF THE
TIP (SEE COMMENT).

COMMENT

COLON AND RECTUM: Resection, Including Transanal Disk Excision of Rectal
Neoplasms
SPECIMEN

Procedure: Right hemicolectomy
TUMOR
Tumor Site: Right (ascending) colon
Histologic Type : Adenocarcinoma
Histologic Grade : G2: Moderately differentiated
Tumor Size: 2.6 Centimeters (cm)
Tumor Deposits: Not identified
Tumor Extent
Tumor Extension: Tumor invades muscularis propria
Macroscopic Tumor Perforation: Not identified
Accessory Findings
Lymphovascular Invasion: Present
Perineural Invasion: Not identified
Treatment Effect: No known presurgical therapy
MARGINS
Margins: All margins are uninvolved by invasive carcinoma, high-grade
dysplasia, intramucosal adenocarcinoma, and adenoma
Margins Examined: Proximal, Distal, Radial or Mesenteric
Distance of Tumor from Radial Margin: 9.2 Centimeters (cm)
LYMPH NODES
Number of Lymph Nodes Involved: 3
Number of Lymph Nodes Examined: 26
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Primary Tumor (pT): pT2
Regional Lymph Nodes (pN): pN1b
Block sent for MMR testing:: A8

Adequate: This case likely has sufficient material for molecular testing,
blocks A8, A9, and A10.

CLINICAL INFORMATION
Lap hand assisted Rt colectomy
Colon CA


GROSS DESCRIPTION
The patient's identification is verified on the specimen container and
requisition.

Received in formalin labeled "RT colon" is a 22.0 cm segment of large
intestine with a stapled distal margin (inked black) resected to include
6.5 cm of small intestine with a stapled proximal margin (inked blue),

Patient KUZMA, XXXXXXX

Name:
DOB: 2/4/1950
Accession: BS-19-0000

Recieved Date/Time:

2/7/2019 14:49 CST

GROSS DESCRIPTION
a 4.8 x 0.7 cm appendix, up to 10.5 cm of attached mesentery with two
stapled mesenteric vascular margins (inked black), and partial omentum
(17.5 x 8.5 x 2.5 cm). The serosa is tan-pink, smooth and glistening with
a slight retraction at the proximal ascending colon (inked blue). The
mesentery and omentum are tan-yellow, focally hemorrhagic, glistening and
lobulated.

The specimen is opened lengthwise to reveal a slightly raised, tan-pink to
red mass (2.6 cm in length x 2.3 cm in width) with a slightly depressed
center corresponding to the retracted serosa. The mass comes to within
1.7 cm of the ileocecal valve, 8.2 cm of the proximal margin, and 18.9 cm
of the distal margin. Sectioning the mass reveals superficial invasion of
the muscularis propria with no extension to the serosa or mesentery. The
mass comes to within 0.2 cm of the nearest serosal surface and 9.2 cm of
the nearest mesenteric vascular margin.

The remaining mucosa is tan-pink, glistening, and normally folded with
a 0.7 x 0.6 cm tan-pink sessile polyp on the ileocecal valve and a
1.2 x 0.5 x 0.3 cm tan-pink, rubbery, smooth surfaced nodule at the
distal ascending colon approximately 1.8 cm from the distal margin.
The remaining ileocecal valve appears slightly granular. Sectioning
the ileocecal valve polyp reveals no grossly identifiable invasion.
Sectioning the nodule reveals no grossly identifiable invasion.
Sectioning the appendix reveals a single pinpoint lumen lined by a
tan-pink, unremarkable mucosa. A single possible diverticulum is noted
at the distal tip. No lesions, perforations, or fecaliths are grossly
identified.

Sectioning the omentum reveals yellow, focally hemorrhagic, lobulated
adipose tissue with no lesions or nodules grossly identified. Dissection
of the attached mesentery reveals multiple possible lymph nodes, ranging
from 0.1-0.7 cm in greatest dimension. Representative sections are
submitted in cassettes A1-A16.

Summary of sections:
A1: Proximal margin and representative distal margin-en face, 3/1
A2: Entire ileocecal valve polyp, 2/1
A3: Uninvolved ileocecal valve, 2/1
A4: Entire distal ascending colon polyp, 2/1

A5: Appendix with longitudinal tip and possible diverticulum, 6/1
A6: Mesenteric vascular margin nearest the mass-en face, 1/1
A7: Remaining mesenteric vascular margin-en face, 2/1
A8: Mass to the nearest serosal surface, 2/1
A9-A10: Additional mass with adjacent uninvolved mucosa, 2/A9; 1/A10
A11: Fifteen intact lymph nodes, 15/1
A12: Ten intact lymph nodes, 10/1
A13: Three bisected lymph nodes, 6/1
A14: Three bisected lymph nodes, 6/1
A15: Two bisected lymph nodes, 4/1
A16: One sectioned lymph node, 4/1
AJU 02:41 PM 2/8/2019

MICROSCOPIC DESCRIPTION
Sections show right colon involved by moderately differentiated
adenocarcinoma. The tumor invades into the muscularis propria. All
margins are negative for malignancy. A tubular adenoma is seen involving

Patient KUZMA, XXXXXXX

Name:
DOB: 2/4/1950
Accession: BS-19-0000

Recieved Date/Time:

2/7/2019 14:49 CST

MICROSCOPIC DESCRIPTION
the ileocecal valve. A sessile serrated adenoma is noted in the
distal ascending colon. 3 of 26 lymph nodes are involved by metastatic
adenocarcinoma. The appendix displays fibrous obliterans of the tip. XXXXXXX M McClain MD

Electronic Signature 02/11/19
_________________________________________________________
Professional services performed at: St XXXXXXX West Hospital XXXXXXX TN CLIA # 44D0000
COMMENT
MISMATCH REPAIR IMMUNOHISTOCHEMISTRY

INTERPRETATION: Intact expression of mismatch repair (MMR) proteins MLH1,
MSH2, MSH6 and PMS2 (MMR proficient)

COMMENT : There is no immunohistochemical evidence of an MMR defect.
However, there are rare families that do have an MMR mutation that
results in a non-functional protein that retains its antigenicity.
Therefore, if there is a high index of suspicion based on clinical and
histologic criteria that the patient may have Lynch syndrome, genetic
counseling and possible additional testing can be performed.

Educational Note:
Individuals with germline mutations in one of the MMR genes are defined
as having Lynch syndrome. There are established clinical and histologic
criteria to help identify patients with increased risk for Lynch
syndrome as set forth in the revised Bethesda Guidelines. Using
immunohistochemistry (IHC) to detect the loss of expression of mismatch
repair (MMR) genes is a complementary method to screen for individuals
with Lynch syndrome. IHC for four proteins including MLH1, MSH2, MSH6
and PMS2 are performed on formalin fixed paraffin embedded tissue. The
loss of MMR protein expression is defined as the absence of any nuclear
staining in the tumor cells with adequate nuclear staining of background
cells such as normal colonic epithelial cells and lymphocytes. If there
is loss of MMR expression, the immunohistochemical pattern can guide
additional testing if clinically indicated. Immunohistochemical staining
was performed and interpreted by Pathology Associates of St. XXXXXXX
_
XXXXXXX XXXXXXX Busler MD
Electronic Signature 02/18/19
_________________________________________________________
Professional services performed at: St XXXXXXX West Hospital XXXXXXX TN CLIA # 44D0000
          

BMP
     

2019-01-30 16:02:49
               



Test Item
     

Value
     

Reference Range
     

Comments

Sodium (test code = 16169)
     

138 mmol/L
     

136-145
     

Potassium (test code = 15665)
     

4.3 mmol/L
     

3.4-5.1
     

Chloride (test code = 13289)
     

101 mmol/L
     

98-110
     

CO2 (test code = 13385)
     

28 mmol/L
     

21-32
     

Glucose Level (test code = 14729)
     

79 mg/dL
     

74-106
     

BUN (test code = 12929)
     

12 mg/dL
     

6-20
     

Creatinine Level (test code = 13553)
     

1.0 mg/dL
     

0.5-1.2
     

AGAP (test code = 10395)
     

9.0
          

Calcium, Serum (test code = 13025)
     

9.6 mg/dL
     

8.7-10.4
     

Glomerular Filtration Rate (MDRD) (test code = 10089)
     

55 mL/min/1.73 m2
          

The GFR is calculated using the MDRD formula and is valid for adults over 18 yea
rs with adjustments for age, sex, and race. The calculation is not valid for pa
tients on dialysis or with rapidly changing kidney function. Patients with GFR
less than 60 are defined as having chronic kidney disease. A grading system o
f decreased kidney function has been proposed: 90 - 60 mild, 59 -30 moderate, 29
-15 severe.
     

CBC w/o Diff
     

2019-01-30 15:44:48
               



Test Item
     

Value
     

Reference Range
     

Comments

WBC (test code = 02281)
     

4.9 x1000/mm3
     

4.5-10.3
     

RBC (test code = 02017)
     

4.58 x0000/mm3
     

4.20-5.40
     

Hgb (test code = 01393)
     

12.0 gm/dL
     

12.0-16.0
     

Hct (test code = 01849)
     

39.0 %
     

36.0-48.0
     

MCV (test code = 00003)
     

85 fl
     

78-98
     

MCH (test code = 00005)
     

26.2 pg
     

26.0-34.0
     

MCHC (test code = 00007)
     

30.8 gm/dL
     

32.0-36.0
     

RDW (test code = 03655)
     

13.0 %
     

11.5-14.5
     

Platelet (test code = 01801)
     

279 x1000/mm3
     

150-500
     
     
Encounters

Start Date/Time
     

End Date/Time
     

Encounter Type
     

Admission Type
     

Attending Clinicians
     

Care Facility
     

Care Department
     

Encounter ID

2019-02-07 07:48:13
     

2019-02-11 19:13:00
     

Inpatient
     

3
     

Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
     

STM
     

Surgery, General
     

0000

2019-01-30 13:39:55
     

2019-01-30 23:59:59
     

Outpatient
     

3
     

Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
     

STM
     

Surgery
     

0000
Payers

Payer Name
     

Policy Type
     

Policy Number
     

Effective Date
     

Expiration Date

BCBS-TN: BLUE ADVANTAGE XXXXXXX (MEDICARE REPLACEMENT PPO)
          

ZXDY0000
     

2015-02-01 00:00:00
     

Blue Cross Blue Shield
     

Commercial
     

ZXDY0000
     

2019-01-21 00:00:00
     

2100-12-31 00:00:00

BCBS BLUE ADVANTAGE MEDICARE PFFS
     

Commercial
     

ZXDY0000
     

2019-01-23 00:00:00
     

2100-12-31 00:00:00
Social History

Smoking Status
     

Start Date
     

Stop Date

Ex-smoker (finding)
          
Vital Signs

Vital NameObservation TimeObservation ValueComments Oxygen Saturation2019-02-11 16:21:3095 %
Respiratory Rate2019-02-11 16:21:3020 /min
Systolic Blood Pressure #12019-02-11 16:21:30144 mm[Hg]
Diastolic Blood Pressure #12019-02-11 16:21:3074 mm[Hg]
Height 2019-01-30 14:31:0067 inches
Weight 2019-01-30 14:31:00205 lb
Body Mass Index2019-01-30 14:31:0032.1 Kilogram per Square Meter
XXXXXXX Kuzma
YYYY@YYYY

i would like to upload the medical records for my sister in law who just had colon cancer. she had the tumor remove and apparently several lymph nodes remove and some were cancerous. so my questions would be, why did they remove this number of lymph nodes, why this amount of colon removed and a good analysis of what she had done and review. i want to upload her info

PatientJOYCE KUZMAAlias
Date of birthFebruary 4, 1950 SexFemale RaceBlack or XXXXXXX AmericanEthnicityNot Hispanic or Latino Preferred LanguageEnglish

Contact info Primary Home:
1042 XXXXXXX LN
Bethpage, TN 37022, US
Tel: (615)766-2704
Patient IDs0000 Ascension Enterprise Solution Architecture
`

Document Id
     

6ed55c00-4683-11e9-931f-00155d7b2c05

Document Created:
     

March 14, 2019, 13:03:12, EST

Performer (primary care physician)
     

No PCP

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (attending physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Performer (admitting physician)
     

MARK UHL

Contact info
     

Address and Telecom information not available
          

Performer (admitting physician)
     
XXXXXXX Polk

Contact info
     

Address and Telecom information not available
          

Author
     

InterSystems HealthShare

Contact info
     

Work Place:
One Memorial Drive XXXXXXX MA 02142, US
Tel: (617) 621-0600

Office contact
     

Maganti XXXXXXX

Contact info
     

Address and Telecom information not available

Legal authenticator
     

HealthShare InterSystems of signed at March 14, 2019, 13:03:12, EST

Contact info
     

Work Place:
One Memorial Drive XXXXXXX MA 02142, US
Tel: (617) 621-0600

Document maintained by
     

Ascension Enterprise Solution Architecture

Contact info
     

Work Place:
One Memorial Drive XXXXXXX MA 02142, US
Tel: (617) 621-0600
Table of Contents

Allergies, Adverse Reactions, Alerts
Medications
Problems
Procedures
Results
Encounters
Payers
Social History
Vital Signs

Allergies, Adverse Reactions, Alerts

Allergy Name
     

Allergy Type
     

Status
     

Severity
     

Reaction(s)
     

Onset Date
     

Inactive Date
     

Treating Clinician
     

Comments

No Known Medication Allergies
     

DRUG
     

Active
                              
Medications

Ordered Medication Name
     

Filled Medication Name
     

Start Date
     

Stop Date
     

Current Medication?
     

Ordering Clinician
     

Indication
     

Dosage
     

Frequency
     

Signature (SIG)
     

Comments
     

Components

Acetaminophen 325 MG / Hydrocodone Bitartrate 5 MG Oral Tablet [Norco]
     

Acetaminophen 325 MG / Hydrocodone Bitartrate 5 MG Oral Tablet [Norco]
     

2019-02-11 06:35:00
          

Yes
     
XXXXXXX XXXXXXX
          

1tab
     

q6hrs
          

Hospital Only: For suspected Oversedation, refer to Oversedation Reversal Policy
     

Nonformulary Medication_Ginseng
     

Nonformulary Medication_Ginseng
     

2019-01-30 14:41:00
          

Yes
               

1tab
     

QDay
               

Garlic preparation
     

Garlic preparation
     

2019-01-30 14:39:00
          

Yes
                                   

Garlic preparation Oral Tablet
     

Garlic preparation Oral Tablet
     

2019-01-30 14:39:00
          

Yes
               

1tab
     

QDay
               

Calcium Carbonate / Cholecalciferol Oral Tablet [Os-Cal 500 with D]
     

Calcium Carbonate / Cholecalciferol Oral Tablet [Os-Cal 500 with D]
     

2019-01-30 14:38:00
          

Yes
               

1tab
     

QDay
               

Nonformulary Medication_Magnesium
     

Nonformulary Medication_Magnesium
     

2019-01-30 14:36:00
     

2019-02-06 14:36:00
     

Yes
               

1tab
     

QDay
               

Trazodone Hydrochloride 100 MG Oral Tablet
     

Trazodone Hydrochloride 100 MG Oral Tablet
     

2019-01-30 14:35:00
          

Yes
               

100mg
     

qBedtime
               

Levothyroxine Sodium 0.05 MG Oral Tablet
     

Levothyroxine Sodium 0.05 MG Oral Tablet
     

2019-01-30 14:35:00
          

Yes
               

50mcg
     

QDay
               

Omeprazole
     

Omeprazole
     

2019-01-30 14:34:00
          

Yes
               

40mg
     

QDay
               
Problems

Condition Name
     

Condition Details
     

Condition Category
     

Status
     

Onset Date
     

Resolution Date
     

Last Treatment Date
     

Treating Clinician
     

Comments

Palpitations
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

GERD - Gastro-esophageal reflux disease
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Hiatal hernia
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Cancer
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Hypothyroidism
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Asthma
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Arthritis
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          

Urinary incontinence
          

PATIENT
     

Active
               

2019-01-30 00:00:00
          
Procedures

Procedure
     

Date / Time Performed
     

Performing Clinician
     

Device

COLECTOMY LAPAROSCOPIC1
     

2019-02-07 12:04:00
          

Resection of Right Large Intestine, Percutaneous Endoscopic Approach
     

2019-02-07 00:00:00
     

12378
     

Colonoscopy 1/2019
               

Tubal ligation
               
Results

Test Description
     

Test Time
     

Test Comments
     

Text Results
     

Atomic Results
     

Result Comments

HCT
     

2019-02-10 03:50:06
               



Test Item
     

Value
     

Reference Range
     

Comments

Hct (test code = 01849)
     

29.5 %
     

36.0-48.0
     
     

BMP
     

2019-02-09 05:36:57
               



Test Item
     

Value
     

Reference Range
     

Comments

Sodium (test code = 16169)
     

138 mmol/L
     

136-145
     

Potassium (test code = 15665)
     

4.1 mmol/L
     

3.4-5.1
     

Chloride (test code = 13289)
     

105 mmol/L
     

98-110
     

CO2 (test code = 13385)
     

26 mmol/L
     

21-32
     

Glucose Level (test code = 14729)
     

88 mg/dL
     

74-106
     

BUN (test code = 12929)
     

8 mg/dL
     

6-20
     

Creatinine Level (test code = 13553)
     

0.7 mg/dL
     

0.5-1.2
     

AGAP (test code = 10395)
     

8.0
          

Calcium, Serum (test code = 13025)
     

8.4 mg/dL
     

8.7-10.4
     

Creatinine Clearance (C - G Modified) (test code = 10371)
     

77.5 mL/min
          

This Creatinine Clearance calculation is an estimate for classification purpose
s only and should not be the only factor used in patient management decisions.
The Creatinine Clearance is a calculation valid for adults over 18 years with
adjustments for age, sex and weight. The calculation is not valid for patients
with changing renal function or patients on dialysis.
OBESITY WT. ADJUSTMENT USED
CREATININE VALUE FOR THIS PATIENT WAS LESS THAN 0.8, THEREFORE CREATININE VALUE
0.8 WAS USED IN THE CREATININE CLEARANCE CALCULATION.

Glomerular Filtration Rate (MDRD) (test code = 10089)
     

83 mL/min/1.73 m2
          

The GFR is calculated using the MDRD formula and is valid for adults over 18 yea
rs with adjustments for age, sex, and race. The calculation is not valid for pa
tients on dialysis or with rapidly changing kidney function. Patients with GFR
less than 60 are defined as having chronic kidney disease. A grading system o
f decreased kidney function has been proposed: 90 - 60 mild, 59 -30 moderate, 29
-15 severe.
     

CBC w/o Diff
     

2019-02-09 05:01:09
               



Test Item
     

Value
     

Reference Range
     

Comments

WBC (test code = 02281)
     

5.6 x1000/mm3
     

4.5-10.3
     

RBC (test code = 02017)
     

3.38 x0000/mm3
     

4.20-5.40
     

Hgb (test code = 01393)
     

8.8 gm/dL
     

12.0-16.0
     

Hct (test code = 01849)
     

29.3 %
     

36.0-48.0
     

MCV (test code = 00003)
     

87 fl
     

78-98
     

MCH (test code = 00005)
     

26.0 pg
     

26.0-34.0
     

MCHC (test code = 00007)
     

30.0 gm/dL
     

32.0-36.0
     

RDW (test code = 03655)
     

13.1 %
     

11.5-14.5
     

Platelet (test code = 01801)
     

200 x1000/mm3
     

150-500
     
     

BMP
     

2019-02-08 06:01:54
               



Test Item
     

Value
     

Reference Range
     

Comments

Sodium (test code = 16169)
     

140 mmol/L
     

136-145
     

Potassium (test code = 15665)
     

5.1 mmol/L
     

3.4-5.1
     

Chloride (test code = 13289)
     

108 mmol/L
     

98-110
     

CO2 (test code = 13385)
     

27 mmol/L
     

21-32
     

Glucose Level (test code = 14729)
     

85 mg/dL
     

74-106
     

BUN (test code = 12929)
     

10 mg/dL
     

6-20
     

Creatinine Level (test code = 13553)
     

0.7 mg/dL
     

0.5-1.2
     

AGAP (test code = 10395)
     

4.0
          

Calcium, Serum (test code = 13025)
     

8.6 mg/dL
     

8.7-10.4
     

Creatinine Clearance (C - G Modified) (test code = 10371)
     

77.5 mL/min
          

This Creatinine Clearance calculation is an estimate for classification purpose
s only and should not be the only factor used in patient management decisions.
The Creatinine Clearance is a calculation valid for adults over 18 years with
adjustments for age, sex and weight. The calculation is not valid for patients
with changing renal function or patients on dialysis.
OBESITY WT. ADJUSTMENT USED
CREATININE VALUE FOR THIS PATIENT WAS LESS THAN 0.8, THEREFORE CREATININE VALUE
0.8 WAS USED IN THE CREATININE CLEARANCE CALCULATION.

Glomerular Filtration Rate (MDRD) (test code = 10089)
     

83 mL/min/1.73 m2
          

The GFR is calculated using the MDRD formula and is valid for adults over 18 yea
rs with adjustments for age, sex, and race. The calculation is not valid for pa
tients on dialysis or with rapidly changing kidney function. Patients with GFR
less than 60 are defined as having chronic kidney disease. A grading system o
f decreased kidney function has been proposed: 90 - 60 mild, 59 -30 moderate, 29
-15 severe.
     

CBC w/o Diff
     

2019-02-08 05:43:30
               



Test Item
     

Value
     

Reference Range
     

Comments

WBC (test code = 02281)
     

7.2 x1000/mm3
     

4.5-10.3
     

RBC (test code = 02017)
     

3.74 x0000/mm3
     

4.20-5.40
     

Hgb (test code = 01393)
     

9.8 gm/dL
     

12.0-16.0
     

Hct (test code = 01849)
     

32.2 %
     

36.0-48.0
     

MCV (test code = 00003)
     

86 fl
     

78-98
     

MCH (test code = 00005)
     

26.2 pg
     

26.0-34.0
     

MCHC (test code = 00007)
     

30.4 gm/dL
     

32.0-36.0
     

RDW (test code = 03655)
     

13.2 %
     

11.5-14.5
     

Platelet (test code = 01801)
     

219 x1000/mm3
     

150-500
     
     

bAddendum
     

2019-02-07 00:00:00
          

Patient KUZMA, XXXXXXX

Name:
DOB: 2/4/1950
Accession: BS-19-0000

Recieved Date/Time:

2/7/2019 14:49 CST


DIAGNOSIS
RIGHT COLON, TERMINAL ILEUM AND APPENDIX, RESECTION:
MODERATELY DIFFERENTIATED ADENOCARCINOMA, MEASURING 2.6 CM IN GREATEST
DIMENSION, INVADING INTO THE MUSCULARIS PROPRIA, MARGINS NEGATIVE FOR
DYSPLASIA OR MALIGNANCY; 3 OF 26 LYMPH NODES INVOLVED BY METASTATIC
ADENOCARCINOMA; TUBULAR ADENOMA AT THE ILEOCECAL VALVE; SESSILE SERRATED
ADENOMA IN THE ASCENDING COLON; APPENDIX WITH FIBROUS OBLITERANS OF THE
TIP (SEE COMMENT).

COMMENT

COLON AND RECTUM: Resection, Including Transanal Disk Excision of Rectal
Neoplasms
SPECIMEN

Procedure: Right hemicolectomy
TUMOR
Tumor Site: Right (ascending) colon
Histologic Type : Adenocarcinoma
Histologic Grade : G2: Moderately differentiated
Tumor Size: 2.6 Centimeters (cm)
Tumor Deposits: Not identified
Tumor Extent
Tumor Extension: Tumor invades muscularis propria
Macroscopic Tumor Perforation: Not identified
Accessory Findings
Lymphovascular Invasion: Present
Perineural Invasion: Not identified
Treatment Effect: No known presurgical therapy
MARGINS
Margins: All margins are uninvolved by invasive carcinoma, high-grade
dysplasia, intramucosal adenocarcinoma, and adenoma
Margins Examined: Proximal, Distal, Radial or Mesenteric
Distance of Tumor from Radial Margin: 9.2 Centimeters (cm)
LYMPH NODES
Number of Lymph Nodes Involved: 3
Number of Lymph Nodes Examined: 26
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Primary Tumor (pT): pT2
Regional Lymph Nodes (pN): pN1b
Block sent for MMR testing:: A8

Adequate: This case likely has sufficient material for molecular testing,
blocks A8, A9, and A10.

CLINICAL INFORMATION
Lap hand assisted Rt colectomy
Colon CA


GROSS DESCRIPTION
The patient's identification is verified on the specimen container and
requisition.

Received in formalin labeled "RT colon" is a 22.0 cm segment of large
intestine with a stapled distal margin (inked black) resected to include
6.5 cm of small intestine with a stapled proximal margin (inked blue),

Patient KUZMA, XXXXXXX

Name:
DOB: 2/4/1950
Accession: BS-19-0000

Recieved Date/Time:

2/7/2019 14:49 CST

GROSS DESCRIPTION
a 4.8 x 0.7 cm appendix, up to 10.5 cm of attached mesentery with two
stapled mesenteric vascular margins (inked black), and partial omentum
(17.5 x 8.5 x 2.5 cm). The serosa is tan-pink, smooth and glistening with
a slight retraction at the proximal ascending colon (inked blue). The
mesentery and omentum are tan-yellow, focally hemorrhagic, glistening and
lobulated.

The specimen is opened lengthwise to reveal a slightly raised, tan-pink to
red mass (2.6 cm in length x 2.3 cm in width) with a slightly depressed
center corresponding to the retracted serosa. The mass comes to within
1.7 cm of the ileocecal valve, 8.2 cm of the proximal margin, and 18.9 cm
of the distal margin. Sectioning the mass reveals superficial invasion of
the muscularis propria with no extension to the serosa or mesentery. The
mass comes to within 0.2 cm of the nearest serosal surface and 9.2 cm of
the nearest mesenteric vascular margin.

The remaining mucosa is tan-pink, glistening, and normally folded with
a 0.7 x 0.6 cm tan-pink sessile polyp on the ileocecal valve and a
1.2 x 0.5 x 0.3 cm tan-pink, rubbery, smooth surfaced nodule at the
distal ascending colon approximately 1.8 cm from the distal margin.
The remaining ileocecal valve appears slightly granular. Sectioning
the ileocecal valve polyp reveals no grossly identifiable invasion.
Sectioning the nodule reveals no grossly identifiable invasion.
Sectioning the appendix reveals a single pinpoint lumen lined by a
tan-pink, unremarkable mucosa. A single possible diverticulum is noted
at the distal tip. No lesions, perforations, or fecaliths are grossly
identified.

Sectioning the omentum reveals yellow, focally hemorrhagic, lobulated
adipose tissue with no lesions or nodules grossly identified. Dissection
of the attached mesentery reveals multiple possible lymph nodes, ranging
from 0.1-0.7 cm in greatest dimension. Representative sections are
submitted in cassettes A1-A16.

Summary of sections:
A1: Proximal margin and representative distal margin-en face, 3/1
A2: Entire ileocecal valve polyp, 2/1
A3: Uninvolved ileocecal valve, 2/1
A4: Entire distal ascending colon polyp, 2/1

A5: Appendix with longitudinal tip and possible diverticulum, 6/1
A6: Mesenteric vascular margin nearest the mass-en face, 1/1
A7: Remaining mesenteric vascular margin-en face, 2/1
A8: Mass to the nearest serosal surface, 2/1
A9-A10: Additional mass with adjacent uninvolved mucosa, 2/A9; 1/A10
A11: Fifteen intact lymph nodes, 15/1
A12: Ten intact lymph nodes, 10/1
A13: Three bisected lymph nodes, 6/1
A14: Three bisected lymph nodes, 6/1
A15: Two bisected lymph nodes, 4/1
A16: One sectioned lymph node, 4/1
AJU 02:41 PM 2/8/2019

MICROSCOPIC DESCRIPTION
Sections show right colon involved by moderately differentiated
adenocarcinoma. The tumor invades into the muscularis propria. All
margins are negative for malignancy. A tubular adenoma is seen involving

Patient KUZMA, XXXXXXX

Name:
DOB: 2/4/1950
Accession: BS-19-0000

Recieved Date/Time:

2/7/2019 14:49 CST

MICROSCOPIC DESCRIPTION
the ileocecal valve. A sessile serrated adenoma is noted in the
distal ascending colon. 3 of 26 lymph nodes are involved by metastatic
adenocarcinoma. The appendix displays fibrous obliterans of the tip. XXXXXXX M McClain MD

Electronic Signature 02/11/19
_________________________________________________________
Professional services performed at: St XXXXXXX West Hospital XXXXXXX TN CLIA # 44D0000
COMMENT
MISMATCH REPAIR IMMUNOHISTOCHEMISTRY

INTERPRETATION: Intact expression of mismatch repair (MMR) proteins MLH1,
MSH2, MSH6 and PMS2 (MMR proficient)

COMMENT : There is no immunohistochemical evidence of an MMR defect.
However, there are rare families that do have an MMR mutation that
results in a non-functional protein that retains its antigenicity.
Therefore, if there is a high index of suspicion based on clinical and
histologic criteria that the patient may have Lynch syndrome, genetic
counseling and possible additional testing can be performed.

Educational Note:
Individuals with germline mutations in one of the MMR genes are defined
as having Lynch syndrome. There are established clinical and histologic
criteria to help identify patients with increased risk for Lynch
syndrome as set forth in the revised Bethesda Guidelines. Using
immunohistochemistry (IHC) to detect the loss of expression of mismatch
repair (MMR) genes is a complementary method to screen for individuals
with Lynch syndrome. IHC for four proteins including MLH1, MSH2, MSH6
and PMS2 are performed on formalin fixed paraffin embedded tissue. The
loss of MMR protein expression is defined as the absence of any nuclear
staining in the tumor cells with adequate nuclear staining of background
cells such as normal colonic epithelial cells and lymphocytes. If there
is loss of MMR expression, the immunohistochemical pattern can guide
additional testing if clinically indicated. Immunohistochemical staining
was performed and interpreted by Pathology Associates of St. XXXXXXX
_
XXXXXXX XXXXXXX Busler MD
Electronic Signature 02/18/19
_________________________________________________________
Professional services performed at: St XXXXXXX West Hospital XXXXXXX TN CLIA # 44D0000
          

BMP
     

2019-01-30 16:02:49
               



Test Item
     

Value
     

Reference Range
     

Comments

Sodium (test code = 16169)
     

138 mmol/L
     

136-145
     

Potassium (test code = 15665)
     

4.3 mmol/L
     

3.4-5.1
     

Chloride (test code = 13289)
     

101 mmol/L
     

98-110
     

CO2 (test code = 13385)
     

28 mmol/L
     

21-32
     

Glucose Level (test code = 14729)
     

79 mg/dL
     

74-106
     

BUN (test code = 12929)
     

12 mg/dL
     

6-20
     

Creatinine Level (test code = 13553)
     

1.0 mg/dL
     

0.5-1.2
     

AGAP (test code = 10395)
     

9.0
          

Calcium, Serum (test code = 13025)
     

9.6 mg/dL
     

8.7-10.4
     

Glomerular Filtration Rate (MDRD) (test code = 10089)
     

55 mL/min/1.73 m2
          

The GFR is calculated using the MDRD formula and is valid for adults over 18 yea
rs with adjustments for age, sex, and race. The calculation is not valid for pa
tients on dialysis or with rapidly changing kidney function. Patients with GFR
less than 60 are defined as having chronic kidney disease. A grading system o
f decreased kidney function has been proposed: 90 - 60 mild, 59 -30 moderate, 29
-15 severe.
     

CBC w/o Diff
     

2019-01-30 15:44:48
               



Test Item
     

Value
     

Reference Range
     

Comments

WBC (test code = 02281)
     

4.9 x1000/mm3
     

4.5-10.3
     

RBC (test code = 02017)
     

4.58 x0000/mm3
     

4.20-5.40
     

Hgb (test code = 01393)
     

12.0 gm/dL
     

12.0-16.0
     

Hct (test code = 01849)
     

39.0 %
     

36.0-48.0
     

MCV (test code = 00003)
     

85 fl
     

78-98
     

MCH (test code = 00005)
     

26.2 pg
     

26.0-34.0
     

MCHC (test code = 00007)
     

30.8 gm/dL
     

32.0-36.0
     

RDW (test code = 03655)
     

13.0 %
     

11.5-14.5
     

Platelet (test code = 01801)
     

279 x1000/mm3
     

150-500
     
     
Encounters

Start Date/Time
     

End Date/Time
     

Encounter Type
     

Admission Type
     

Attending Clinicians
     

Care Facility
     

Care Department
     

Encounter ID

2019-02-07 07:48:13
     

2019-02-11 19:13:00
     

Inpatient
     

3
     

Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
     

STM
     

Surgery, General
     

0000

2019-01-30 13:39:55
     

2019-01-30 23:59:59
     

Outpatient
     

3
     

Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
Polk, XXXXXXX
     

STM
     

Surgery
     

0000
Payers

Payer Name
     

Policy Type
     

Policy Number
     

Effective Date
     

Expiration Date

BCBS-TN: BLUE ADVANTAGE XXXXXXX (MEDICARE REPLACEMENT PPO)
          

ZXDY0000
     

2015-02-01 00:00:00
     

Blue Cross Blue Shield
     

Commercial
     

ZXDY0000
     

2019-01-21 00:00:00
     

2100-12-31 00:00:00

BCBS BLUE ADVANTAGE MEDICARE PFFS
     

Commercial
     

ZXDY0000
     

2019-01-23 00:00:00
     

2100-12-31 00:00:00
Social History

Smoking Status
     

Start Date
     

Stop Date

Ex-smoker (finding)
          
Vital Signs

Vital NameObservation TimeObservation ValueComments Oxygen Saturation2019-02-11 16:21:3095 %
Respiratory Rate2019-02-11 16:21:3020 /min
Systolic Blood Pressure #12019-02-11 16:21:30144 mm[Hg]
Diastolic Blood Pressure #12019-02-11 16:21:3074 mm[Hg]
Height 2019-01-30 14:31:0067 inches
Weight 2019-01-30 14:31:00205 lb
Body Mass Index2019-01-30 14:31:0032.1 Kilogram per Square Meter
XXXXXXX Kuzma
YYYY@YYYY

thanks for the reply. can you review the blood work. i notice her rbc has dropped so give me a review of her blood work and give we what you think about her current health based on her blood work after the surgery
thanks

thanks for the reply. can you review the blood work. i notice her rbc has dropped so give me a review of her blood work and give we what you think about her current health based on her blood work after the surgery
thanks

i meant to add this to the last question. how do they know if they got it all and why did they take out the number of lymph nodes that they took out. why not more or less
thanks

i meant to add this to the last question. how do they know if they got it all and why did they take out the number of lymph nodes that they took out. why not more or less
thanks

im sorry i do not understand...
"Surgeon has to take out the adjacent nodes in totality, number is counted later by pathologists. This is required for disease control. As already 26 removed in her, it's a good number and surgery will be considered adequate in her"

the dr told XXXXXXX that they took out 7 lymph nodes and 2 had cancer. why 26 and does this mean no cancer in 23 nodes and when do think follow up should be with oncologist
thanks plus your professional thoughts on this case

im sorry i do not understand...
"Surgeon has to take out the adjacent nodes in totality, number is counted later by pathologists. This is required for disease control. As already 26 removed in her, it's a good number and surgery will be considered adequate in her"

the dr told XXXXXXX that they took out 7 lymph nodes and 2 had cancer. why 26 and does this mean no cancer in 23 nodes and when do think follow up should be with oncologist
thanks plus your professional thoughts on this case